The Blue Cotton Gown (15 page)

the pelvis again and the cervix eight centimeters dilated.

“Why don’t you start pushing, Caroline? Just lean on the baby, add a little oomph to the contractions.”

An hour later, the patient is completely dilated. That’s when everything hits the skids. As the baby begins to descend into the birth canal, the fetal heart rate drops below ninety. We roll Caroline on her side and I feel in the vagina for a thick rubbery cord com-ing in front of the baby’s head, one of my worst nightmares, but there’s no cord, just a little round head as hard as a potato. As Caroline’s pain eases off, the fetal heart rate improves. Four more contractions, same story. Each time, the fetal heart rate falls lower, takes longer to return to where it is supposed to be.

“Call Dr. Harman, Joy. Tell him I need him here now.” The nurse nods and bustles out of the room. I have dealt with many complications, including babies born with the cords around their necks, but part of being a good midwife is knowing when a patient might need a cesarean section and when to call an OB to your side.

“Oh
no,
I have to poop!” Caroline cries with big eyes. Then, realizing it’s not poop, the young mother puts her chin to her chest and pulls back her legs, instinctively. Her labia open, and a baby’s head, covered with black hair, is right there. The fetal heart drops again, this time to fifty.

“Push hard, Caroline. This is the most difficult part for the baby.

Push like
your baby’s life depends on it.
”

The nurse returns, sees what’s happening, and pulls up the

gooseneck lamp and the stainless-steel table. “Dr. Harman’s on his way. It will take five minutes, maybe ten.” She glances at the clock on the wall. Caroline growls deep in her throat, not waiting for Tom, and I don’t want her to.

“Push!” I exhort. “Push like you mean it. Make every push count.” I give a low, prolonged groan from deep in my abdomen to demonstrate. Jay, aware of the slow fetal heartbeat, bends low with his arms around his wife and grunts too.

Then suddenly the head is crowning. “Blow, blow!” I hold up my hand like a traffic cop. “I have to check for a cord around the neck and then you can push again one more time.”

Running my fingers along the side of the baby’s neck, I feel for a smooth rope-like piece of flesh. An umbilical cord around the neck is not unusual, but when I find this one and try to slip it over the in-fant’s head, it’s too tight. I try again, put some muscle into it, and this time the rubbery cable of flesh slides over. But wait! There’s another loop.

“I got to push again!” yells Caroline as she uncontrollably bears down. “It’s coming!”

“No! Blow! Jay,
make
her blow. There’s more cord here and if she

pushes it will tighten.”

But there’s no stopping Caroline now. As the baby emerges, his face dark blue from near strangulation by the umbilical noose, he lets out a cry and spins in my hands, unwrapping the cord that is still tangled around his chest and shoulders.

At that moment, Tom walks into the room, pulling a blue sterile gown over his shirt and tie. “Hey, nice work,” he says, noting the crying baby I’m placing in Caroline’s arms. “I shouldn’t have hurried.”

“Cord around the neck times two and twice more around the chest,” I report, holding up the now flaccid rope of flesh, twice as long as normal. “It must be almost four feet. We’ve had deep decelerations with every contraction for the last fifteen minutes.”

Tom pats me on the shoulder, understanding the pressure I was under.

“Nice work, everyone. No wonder your baby couldn’t make up his mind which way to come out; he was dangling from a bungee cord.” My husband smiles his wonderful smile.

*

Such a special event, bringing new life into this world, how could I ever forget the Akitas’ birth? Still, I comfort myself, there are so many birthing stories, more than a thousand, and even though I’d barely recognized Caroline’s face, when she’d reminded me of the details of her delivery, it was all right there, her labor and birth, embroidered with colored thread on my heart.

“Better get a move on, babe. You’re running behind.” Celeste swats me on the butt with a yellow chart, and I drop with a thud back into the world of the clinic. Seven more patients to see before lunch.

At ten thirty, Dr. Harman shows up, wearing scrubs and two hours late for clinic. He doesn’t speak to anyone, just grabs his stethoscope and heads for his first exam room. There’s no chitchat among the nurses, no joking, no gossip, no stories about their families. When I get a chance, I pull Celeste into my office. “What’s going on?” I ask her. “I saw Donna crying.”

“It’s her father. He had another heart attack and is over in the hospital. She didn’t really want to be here but says working keeps her mind off what’s going on with him.”

“Shit.”

“Yeah, it’s bad . . .” Celeste lowers her voice. “What’s up with Dr. Harman?”

“It’s Mrs. Teresi. They took her back to the OR this morning. It’s the third time. Her blood pressure was dropping and the general surgeon wanted to go back in. Tom won’t even talk to me about it.”

Celeste sighs, sweeps her dark hair away from her face, and clips it to the top of her head in an asymmetric ponytail. “I hate to see him this way.”

“Are you doing okay?” I ask her.

She wrinkles her nose like something reeks. “Sometimes this place gets me down . . . the weight of it.” A chime rings from Tom’s exam room, signaling he needs a nurse. “Gotta go,” Celeste says. I press my lips together and stare out my office window. The leaves at the tops of the maple trees are just starting to turn red. Dark clouds in the west threaten rain. At least when I was in the birthing room with Caroline, there was nothing to worry about but

one mother, one baby.

Yeah,
I think,
sometimes this place gets
me
down too.

trish

“Did you hear about Trish’s daughter?” Donna whispers, pulling me aside as I enter the clinic, ten minutes late, on Wednesday morning.

“What?” I swing around.

“Aran’s boyfriend, Jimmy, lost his job and ended up in intensive care after overdosing on Oxycontin.” She bends in close, says con-spiratorially, “Aran spent the whole night in the reception area
by herself,
waiting to see if he would pull through.”

I lay my canvas briefcase down in the hall with more care than it deserves and go very still. “How did you hear that? Are you sure? Aran hasn’t been seen in the office since she transferred to the teen OB clinic at the university, weeks ago.”

“Vi, the receptionist in family medicine, told me. She heard about it when Trish called to tell them she’d be coming in late because she had to go to the hospital. Aran didn’t even telephone her folks to let them know what was happening. Just sat up all night,
alone.
”

“Thanks for telling me, Donna. Is Trish in yet?” “I’m not sure. Want me to call down there?”

“No, that’s okay. I’ll wait.” All morning, women come in for an-nual exams, abnormal periods, and OB visits, but I’m thinking only of Trish and Aran.

By late afternoon Trish sits in my office, smoothing her daisy-print scrub jacket and crying. Her oval face is mottled and wet. “Well, Dan was right. Remember, he thought Jimmy was into drugs? But it’s not just marijuana. It’s needles and pills. He’s out of the ICU and he’ll survive, but he’ll be hospitalized for another twenty-four hours. Of course, he feels terrible, apologizes for caus-ing us trouble, tells us he loves Aran, and in his way I know he does. He promises he’ll stop using, but he has no insurance and the bill will probably be fifteen thousand dollars.” She wipes her nose with the back of her hand. I sit facing her, my knees touching hers. Trish pulls back her sandy hair with both small hands, staring out the win-dow and watching her hopes for her pregnant daughter whirl away like the leaves off the autumn trees.

Finally I ask, “Where’s Aran now?”

“She’s sleeping. She called off work. Told them she was having contractions.” Trish lets out a sad breath. “I don’t know what to do anymore. Dan isn’t speaking to anyone. He’d just like to lock Aran in her room. Keep her under house arrest. This craziness is tearing our family apart.”

I gaze at my friend. I’m amazed that Trish manages not only to function but to do her job well in the midst of this chaos. She’s such a steady, good person. “I don’t know how you do it, Trish. What keeps you going? You feel like your family is falling apart, but you just keep on trucking.”

My friend shrugs and raises one eyebrow. “What choice do I have? We’re raising two other kids besides Aran, remember? They need some kind of life.”

We stare at each other.

“Did I tell you when things were really out of control at our house, when the boys were getting into trouble, how I ran away from home?” I ask her.

Trish nods sadly. Yeah, she’s heard the story.

Run Away

I share pretty much everything with my patients. I tell stories about myself. I tell stories about other women, about friends and patients. I’m always careful to change the place and time of the encounters because in a small community, you never know who knows who. I disguise the details, saying, “I had a patient once, this was quite a few years ago,” or “This was when we lived in Ohio . . .”

Sometimes I tell mothers about the troubles Tom and I had when the boys were teenagers. I tell them how I wanted to run away. I was so tired of feeling afraid for them and feeling guilty that I’d screwed up. Sometimes I tell them that I did run away. This is the truth. It was around the time Orion was picked up downtown by the paramedics.

He was sixteen, I think, and was late for his twelve-o’clock cur-few . . . the details blur after a while, fifteen or sixteen. Tom and I were in bed, but neither of us was sleeping.

The phone rang. Tom picked up. “Dr. Harman,” he said in his doctor voice. The phone ringing that late didn’t particularly alarm me. We were still doing deliveries and were often called in at night. What scared me was the way my husband sat up in bed and dropped his feet to the floor.

“When? . . . How are his vitals?” There were long gaps in the conversation. “I’ll be right in.” I felt nauseated. The word
his
was the tip-off. Our patients are female.

“What? What’s happening?” I switched on the bedside lamp.

“It’s Orion. The squad brought him into the university hospital’s ER.”

“An auto wreck?”

Tom pulled on his jeans. “No, he’s in a coma.” Our eyes met, say-ing everything. “Could be head trauma. Could be booze. His blood-alcohol level is real high. They found him in one of the row houses in the university student district. Someone called the squad, but no one was there when the paramedics arrived, so they don’t know what happened. They’re taking him in for a CT now.”

“Should I come?” I started to get up.

“No, I’ll call you.” My husband left and I stayed in bed, praying. When Tom returned, five hours later, he told me what’d happened. Someone had called the squad, but when the paramedics got to the Clifton Street address they found Orion abandoned on the floor of a trashed-out living room, hip-hop music blaring and a keg

of beer on the kitchen counter.

Orion was in the hospital unconscious for seven hours before anyone knew whether it was an overdose or a head injury, maybe from a fall or an intentional blow to the head. It turned out to be alcohol poisoning. I think this was the same year Zen was expelled for having ten little baggies of marijuana on the high school campus after a basketball game.

During this time, I was insane with worry. The only one of the boys who seemed to be doing all right was Mica, in college in Con-necticut. There’d been that incident when he’d worked as a pizza delivery man and was kidnapped by a group of thugs who’d forced him at knifepoint to drive to his ATM and take out money for them and then stole his car, but that was earlier. If he was in trouble now, we didn’t know about it, and that was okay with me.

Those were the years when I began walking the floors. I stopped sleeping with Tom, camped in my study, and prayed on my knees, but I never missed work. I smiled and was nice to the patients. I told no one what was going on at home, that we were losing control of

our children and that I was afraid if they didn’t end up dead, they would end up in prison. I had no one to tell, no friends or colleagues who had kids being hauled in by the police or found almost dead by paramedics. The only thing that soothed me were my fantasies of flight.

Whenever I was alone, I would imagine a cozy home free of fear and fighting, some safe, calm haven. I would visualize myself packing the Civic, going into detail about what I would take: a few framed photographs, my favorite blue quilt, books, CDs. I pictured myself packing my guitar, my cameras, some kitchen things, a suit-case of clothes, a book of poetry. My escapist plans gave me peace, and I reviewed them over and over.

And then one day, something, I can’t remember what, pushed me over the edge. It might have been Zen’s acid trip when he thought he was God and we had to drive to Philadelphia to get him, or maybe it was when he stood in the TV room and called me a bitch. Whatever had happened, I went to the phone, found an apartment, wrote Tom a note, and left. I’d spent so much time thinking what I would pack, it was easy.

In the halls of the faculty OB clinic, Tom and I saw each other daily. We were professional and polite, but looked at each other with eyes like wounds in our faces. Sometimes Tom would visit my little furnished studio, which was as sweet and quiet and lovely as I’d imagined. There was a fold-down bed like in the old movies, a kitch-enette, and a small dining table. I smoothed my patchwork quilt over the sofa and put up a few pictures on the white walls. Outside the front window I hung a bird feeder, and in the evenings, I would watch purple finches fight over millet and flax seeds.

“I want to move here too,” Tom complained after we made love on the blue and white quilt. But we couldn’t
both
run away at the same time. Someone had to be responsible and stay with the boys. I was gone for three months, and then one night after work I moved home and cooked dinner.