The Blue Cotton Gown (21 page)

all along, at least every few months, but it makes me so low.”

In the lab I dig around for some samples of medication. I’ll have to take the pills for almost two weeks. A few days after I stop the progesterone, I’ll have an artificial period, which will get rid of the excessive bloody tissue. Meanwhile, we’ll wait for the results of the sampling Tom did tonight.

Unopposed estrogen can cause uterine cancer, but I’ve had biopsies before. They were fine. This will be fine too. Sometimes Tom Harman gets on my nerves. In the bathroom I swallow two progesterone pills.
Might as well get the show on the road,
I think grimly, looking at my face in the mirror. When I check my pink cotton underpants, there’s more blood.

icy

I’m stuck in a line of vehicles on Turkey Run, a narrow blacktop that runs between the agricultural school and the freeway. It’s five o’clock, as close as you get to a rush hour in Torrington, and I’m on my way home from work, listening to a CD of John Sousa marches. I’d be better off on days like this if I rode my bike, only there’s no berm to ride it on. To my left, the sun is dipping behind the bare trees. The stirring music reminds me of Icy, a patient I saw in clinic today.

Icy Miller is an eighty-six-year-old widow, a fluffy, soft, pink-skinned, white-haired lady who lives at Valley Manor, a retirement village not far from the office. I was the first woman she’d ever seen for a gyn exam. Now she sees me four times a year for a pessary check and cleaning. The three-inch rubber device, shaped like a doughnut, is worn by some older women in the vagina to support a vaginal prolapse. It’s an alternative to surgery. Icy’s in good health except for her blood pressure. At eighty-six, she still drives her own car.

In the exam room I ask Icy how she is. “I’m fine really, just hav-ing a problem.”

“What’s going on? Didn’t I see you just last month?”

“Well, it’s a little embarrassing. I went down to Florida to see my sister and I got real constipated. I strained too much and now the pessary’s out of place.”

“Did you fix your constipation?”

“Oh yes, days ago. You know how it is when you travel. You don’t take care of your bowels, you don’t eat the foods you’re used to.” I help Icy lie down and put her narrow arthritic feet in the footrests and then with a gloved finger carefully remove the pessary.

It was halfway out and rubbing the side of her vagina. Simple for me. Not so easy for her.

“So how’s the rest of your health? Did you have a good time in

Florida?” I stand and wash the rubber disk at the sink, looking over my shoulder, taking my time. It’s a treat to hang out with Icy. There are some patients you just like, you don’t even know them that well and you like them. It’s their life force or something. I replace the pessary with a little push.

I’m finishing up, writing a few notes in the chart about the short visit. “Do you know where you’ll get your flu shot this year, Icy? There may be a scarcity again.”

“No, I don’t. I went to Dr. Sutton last week, he’s my internist, and they don’t have them, don’t think they can get them either. I don’t know what this country’s coming to that we can’t make our own flu shots. We seem to have plenty of money to throw around the Middle East.” Her brown eyes snap in her wrinkled pink face and I raise my eyebrows.
This is interesting.

“You think that’s a waste?” The patient turns sideways on the exam table as easily as if she were a girl, and leans forward. “Of course, and I think it’s
wrong.
What do they think they’re doing with our American boys and girls? Throwing their lives away. It makes me sick, really. This country is falling apart, the economy and all. And that money we’re spending over there, it’s over
three hundred billion dollars
already and it will be over
five hundred billion
before we get out! Maybe a trillion. Think of the highways and hospitals we could build. Think of the schools and housing for the poor.”

Right now, I look out my side window at Turkey Run Road, full of potholes, the berm washed away. I had no idea; could Icy be right? I think of the homeless; the high school dropouts; the loss of lives in the war, ours and theirs; the amputees . . . five hundred billion dollars?

“You know what, Icy? I think like you do, but I rarely say so to patients. Dr. Harman and I used to go to marches and sit-ins. Now we donate money to a few causes, but otherwise I don’t say much.” “Well, you
should.
Not enough people say what they believe.

That’s how the government gets away with it.”

I wince, knowing she’s right. “But don’t you suppose it would of-fend my patients?”

The line of vehicles on Turkey Run moves ten feet forward and I’m now only two cars from the intersection.

“Oh, honey, you won’t. They know you love them and take good care of them. You might even have a good influence. That’s one of the privileges of getting older. You get to say what you believe. Your words are worth something. You need to march on.”

“You think so?”

“I know so!” The patient’s brown eyes sparkle. “Now give me a hug.”

Mrs. Miller throws out her arms and I move into them against her big soft breasts. She smells like cedar, good sense, and courage. It’s finally my turn to cross Bobtown Road. I wait for two minutes and at last shoot through the traffic. Then I open my window, turn up “Stars and Stripes Forever,” and let it blast, not caring who

hears or who it disturbs.

patsy

It’s been a brilliant blue day, cold and clear, and the sunset is just as radiant. Tom and I have finished dinner, stir-fried vegetables with chicken. We sit now in the living room, watching the sky turn from gold to red to lavender, until it’s dark. As I rise to carry the dishes into the kitchen, he clears his throat. “The pathologist called about your endometrial biopsy today.”

“And . . . ?”

“It’s complex hyperplasia with atypia. He can’t rule out endometrial cancer.”

“I don’t get it.” I understand it isn’t good, but I don’t know how bad.

“Well, it means you have an overgrowth of abnormal cells in your uterus that could be cancer, he’s not sure.”

“What’s he think?”

“Pathologists don’t
think.
They don’t guess. That’s why they say ‘a low-grade carcinoma cannot be excluded.’ ” My husband pulls the printed biopsy report, which is neatly folded in quarters, from his front shirt pocket. I spread it out on the kitchen counter and read the words twice, then go back to rinsing the stainless-steel sink. I feel Tom watching, but I don’t look up. I’ve just been pushed off a cliff and am falling.

“I didn’t want to tell you at the office.”

I’m having a hard time hearing. The wind is roaring too loud as I plunge, tumbling over and over again.

“So what do we have to do to find out?” I say finally, shaking my head to clear it.

“Well, the usual treatment is a hysterectomy.”

I’m sick with remorse. If I’d gotten the ultrasounds on a regular basis or told Tom when I first started spotting, this might not have happened. I’m always so busy, in so much of a hurry. Now I may have cancer, and it’s my own fault.

“So what are the chances?” I ask as we return to the living room. The Christmas tree, decorated with tiny white lights, birds of all kinds and golden pinecones, sits in front of the windows that face the lake. The smell of Scotch pine fills the room. “I don’t feel tired or ill. I don’t think I have cancer. Shouldn’t I have pain or be losing weight? I feel great.”

Tom shrugs. “The thing is, I can’t take care of you in this. I told you. I can’t be your doctor.”

“I know that,”
I snap. “I’ll find my own doctor. I just wondered,

if I were your patient sitting in your exam room, what advice would you give me?”

“Have a hysterectomy. Then the problem is solved. You can use estrogen and never worry about taking progesterone again
and

you’ll know you don’t have endometrial cancer because you won’t have a uterus.” He smiles a half smile, thinking that’s amusing, and squeezes my hand.

I don’t squeeze back. “I told you, I
really
don’t want a hysterectomy. Aren’t there alternatives? It just seems wrong to have a hysterectomy if we don’t even know
for sure
I have cancer.” It pisses me off. I know that the removal of a woman’s reproductive organs is the second most common surgery performed in the United States. Cesarean section is first. Each year, more than six hundred thousand are done. One in three women in the United States has had a hysterectomy by age sixty.

Tom shakes his head and lets his air out. “Okay,” he says. “We can do a lit review on the Internet. I’ll get on PubMed. What do you need to know?”

“Well, I want to know what the chances are with this kind of endometrial biopsy. What’s the chance I have cancer.? Fifty percent? Five percent?”

“Yeah, endometrial cancer grows slowly so we have some time.” “No, I need to know tonight.”

Tom shakes his head and reaches for me. “Come here.” I scoot across the couch, and he wraps his arms around me. “It will be okay. Even if you have a hysterectomy, what’s the big deal?”

I draw back to stare at him. He doesn’t get it. Jumping up, I move to the Christmas tree. “I just got over surgery with the gallbladder eight months ago. I hated it. I felt so vulnerable and out of control. It was one of the worst things that have happened to me.”

“You did fine. You recovered great once you got home.”

The smell of the pine needles fills the room as I stand with my back to him, randomly crushing them. “And what about sex?” I ask, wiping my tears surreptitiously. “Don’t you care about that? Sex won’t be the same.”

“Actually, that’s not true. They’ve studied that,” Tom says this in his doctor voice. “The majority of women after hysterectomy have more frequent intercourse and more pleasure.” He sounds like an

actor in a white coat playing a physician in a TV ad. “More frequent intercourse and more pleasure—”

“Yeah, right! That’s because most of them had pain before the surgery or were bleeding all the time, so of course sex is better. I see those women in the clinic, the same as you. Some even have worse pain
after
surgery because of adhesions or scar tissue at the top of the vagina.”

The room is illuminated only by the miniature Christmas lights. I pace behind the couch and love seat, crying again, but he can’t see. “It won’t be the same! When I have an orgasm I use my whole body. I feel the contractions in my uterus as much as my vagina. How would you like to have an orgasm without a penis?” I’m getting carried away here. Tom slides down on the sofa, looking up at

the ceiling. “Well?” I ask.

“Sex is ninety percent in the mind.”

“So you don’t think a woman needs a uterus?” I’m offended and irrational but I can’t stop.

He stands up. “Let’s cool off. We don’t have to do anything tonight. Do you want an appointment with Dr. Parsons, Dr. Hazleton, or Terrance at State?”

“I don’t care,” I say, pouting. “How about Dr. Burrows?” This is a joke and Tom knows it. “Okay, Eleanor Parsons, I guess. I’d probably be more comfortable talking to a woman about sex . . . if it comes to a hysterectomy.”

For the rest of the evening we research the incidence of uterine cancer with a biopsy result of complex hyperplasia with atypia. We peck away on our computers, each in our separate studies. I’m surprised to read that the chances of my having cancer are 30 percent. More than I thought. I still don’t think it’s that likely.

At midnight we go to bed. We’re lying back to back and Tom reaches around and gives me a pat.

“Don’t you worry about sex, Tom?” I ask softly into the dark. “Not too much. I think you’ll be fine. I know you better than you

know yourself.” He adjusts his pillow. “You’ll be fine.” In a few minutes I hear his breathing slow down and know he’s asleep.
Mr. Positive.

Tom always anticipates the best, while I am full of doubt. I could turn to hold him, to let him hold me, but I don’t.

I completely forget to light the prayer candle.

*

At the end of the week, Tom and I have an appointment late in the afternoon with Dr. Eleanor Parsons, a gyn surgeon in Delmont. The waiting room is a 1950s sort of space. Signs all over the glass at the receptionist’s desk remind patients they must pay at the time of service, and blue vinyl chairs without armrests are lined up facing a TV mounted high on the wall. A lone secretary glances at her watch as she greets us with a clipboard of forms.

“Mrs. Harman,” she calls a few minutes later and opens the door to the inner office. She is apparently both receptionist and nurse, and we follow her down the narrow hall, past the empty exam rooms.

At the door to her office a sturdy woman with sandy gray hair stands waiting. “Well, come on in!” the physician shouts, sounding as if we’d just come for a party. Eleanor Parsons is wearing a flowing black jacket with a leopard-print top over black narrow slacks and is holding out her arms. I tower over her. After giving us both big hugs, she graciously indicates we should take the two leather chairs across from her cherrywood desk. Her private office makes up in elegance what the waiting room lacks.

Before leaving the university and starting out on his own, Tom had worked with Eleanor on the ob-gyn faculty at State. For a few minutes, the two physicians chat about their children and what it’s like to be in private practice, and then Dr. Parsons turns to me. Tom had called ahead, so she knows the story.

“So how are you feeling?” she asks in a soft South Carolina ac-cent. I’ve been inspecting her paintings on the wall, the huge desk, the bookcase, but I rejoin the party; after all, it’s for me.

“Okay, I guess. We’ve been thinking about what’s the next step, and we’ve done some research.”

“Well, I did some research last night too, after we talked.” She’s looking at Tom. “It isn’t standard of care, but since Patsy can’t take progesterone orally, I agree, the progesterone IUD may be the way to go. It will control the thickness of the endometrium without hav-ing a systemic effect.”

I’m relieved that
hysterectomy
wasn’t the first thing out of Eleanor’s mouth. The two surgeons go on to discuss the protocol. Dr. Parsons’s face is lined and pale, but there’s a great kindness in her. She turns to me. “So when would you want to get the D and C, Patsy?”