The Blue Cotton Gown (25 page)

I let out a breath. “Nila, I can’t do this. Abby told me I’m not supposed to mention the black eye, but you think I’m blind? What’s going on? The birth control problem is one thing, but you look like hell and you’ve lost weight. Is it Doug?”

“No, not Doug. It’s Gibby.”

“Did
he
hit you?” I’d forgotten about Gibby, the estranged husband.

“Not hit, really. He was trying to get in the house. While I was

struggling to lock the door, he pushed it open and it bashed up my face. He’s real sorry.”

“Well, what was Gibby
there
for? What did he want?”

“Oh, he said he was there to talk, but I didn’t want to. He’s still sending flowers, trying to get back with me.” I remember the small man, about five foot six, muscular, with a thick neck and blond hair that showed on his chest at the front of his open work shirt. He’d never come to prenatal visits but was at the births of their younger children.

“What does
Doug
say?”

“Oh, he was going to go after Gibby. He’s a big man and could do some damage, but I said, Leave it be. Gibby didn’t mean to hurt me. Now Doug’s fed up. Says I shouldn’t be talking to Gibby
at all,
that I’m leading him on. Says we should at least call the police again.”

“Call the police
again?
”

“Yeah, we tried before but they didn’t do anything. They said they couldn’t make an arrest or set up a restraining order based on his making
threats.
”

“What do you mean,
threats?
Gibby has threatened you?” “No, not
me.
It’s Doug. He says he’ll kill him.”

I’m silent for a minute. This is out of my league. “So do you love Gibby? Do you want to be with him?”

“No, I love Doug, but he says Gibby’s crazy, that he’ll never leave us alone. He wants to go back to South Dakota, but I have the kids to think about. They just started school. Gibby will get over it once the divorce is final.”

“You’ve filed for a divorce?”

“Yeah, I saw an attorney. I’m just hoping the black eye goes away by the next time I see him.”

I shake my head. “Nila . . .”

“Gibby is not an evil guy, Patsy. He’s just
upset.
I understand. We grew up together. You excuse a person you’ve known and loved for

this long. You understand them. Doug is the one I’m worried about. He’s not used to this.”

We both study the floor.

“Well, let’s get your periods straightened out. Maybe the patch isn’t strong enough.”

“No, I don’t think birth control hormones agree with me. We’ll just use condoms.”

“But can you be real careful with condoms, Nila?”

The small woman crinkles her eye, her one good eye, then tilts her head. “I guess we’ll
have
to.”

I fill out a requisition for a CBC and thyroid labs to check the patient’s blood count to see if she’s anemic or has a thyroid disorder that would screw up her periods, then I reach into the cupboard over the sink and hand Nila a month’s supply of multivitamins with iron. “Don’t bother to cancel your other return appointment. I want to see how you’re doing.” Nila nods.

I don’t just mean the woman’s periods. I mean everything else.

chapter 13

Money Changer

For once I’ve not relied on my husband or others to make a decision. I’ve found an accountant, Donald Collins, CPA, of Collins and Red-man Financials. He’s employed by five other medical groups in Torrington, and they all think he’s great. Mr. Collins has already reviewed our quarterly tax statement and found three errors. The bill is now down to $11,341, which is still not small change, but better than fifteen thousand dollars.

It was hard firing Rebecca, but it’s done. In cowardly fashion, we sent her an e-mail telling her that we needed an accountant who had more experience in health-care management. It was the chicken’s way out. We never explained how disappointed we were with her. She shot a sharp e-mail back and warned that we’d be sorry for dropping her, but we held firm.

Donald has already met with us twice in the office. He understands our frustration at having no fiscal leadership and suggests that Tom take a temporary salary reduction until we catch up. I don’t like it. My husband works hard, harder than many gynecologists who make far more money, but Tom agrees. He says he would rather earn less and have more peace of mind.

This evening after work, sitting near the corner window in the living room, staring at snow drifting sideways like feathers after a pillow fight, I wonder if we did the right thing when we gave up OB, but what choice did we have?

When the cost of medical-liability insurance almost doubled, we

looked at what it would cost to continue obstetrics, and we couldn’t break even. Bringing new life into the world in a gentle way was our calling, but a calling we could no longer afford.

jeannie

A quiet Saturday afternoon, with a cup of tea, watching the gray squirrels rob our birdfeeders. Seeing Jeannie Perry yesterday for her gyn annual reminded me of the
nonmonetary
rewards of delivering babies. The slender, dark-haired, thirty-six-year-old woman had been Tom’s infertility patient. She’d been trying to get pregnant for five years and had been through all the tests, even surgery. She’d also tried artificial insemination with her husband’s sperm three times, without success. Then the couple got pregnant on their own one warm spring night. Wouldn’t you know it?

A year before we gave up our OB liability policy, we sent out letters to all our patients, telling them that as of January 1, we would no longer be doing deliveries. There were hundreds of women try-ing hard to get pregnant in the following months. Jeannie was one of them, and she just made our deadline. Her due date was January 3, three days
after
our insurance would be terminated, but we were counting on her going early.

As the holidays came and went, Tom and I waited for a phone call from Jeannie, but no call came. A few days before New Year’s, I checked the young woman in the exam room and what I found wasn’t good. The baby was head down, but Jeannie’s cervix was closed. “Are you having
any
contractions, Jeannie?”

“Not many. I think something’s wrong.” Jeannie pulls her long straight dark hair back from her face.

“Yeah, can’t you do something?” Nathan, her husband, mutters leaning forward in the guest chair. “It took so long to get this baby.

How many more days do we have wait for it to come out? What will we do if you can’t deliver?”

I go over all the things I usually recommend to stimulate contractions—make love, take primrose oil, go on long walks—and then I sum up the situation. “If by December twenty-ninth nothing has happened, we’ll admit you to the birthing center and give you a jump start. Sound like a plan? We won’t let anything happen to your baby. Don’t worry.”

Saturday the twenty-eighth comes and goes. No phone call from Jeannie. Sunday morning. Coffee in front of the Christmas tree with Tom. (This was last year, before our IRS troubles, the gallbladder surgery, and cancer; before our little world blew apart.)

“So, Jeannie’s coming into the hospital this afternoon,” I remind Tom. “Today’s the day . . . or tonight. One of us will have to go into town to admit her and get things going. I hate to tie up our weekend, but there are only a few more days left before January one.” He flips his warm palm over to hold my hand. “Let’s both go.

It’s probably our last birth together. Call it a date. We’ll get the in-duction started, then go to a movie. I’ve been nervous about this delivery all week.” This catches my attention, and I wait for more. Tom’s rarely anxious about obstetrics. “You heard what happened a few months ago to Dr. Gorday? Her last delivery before she retired? It was a disaster. The baby’s head came out but the body was stuck, shoulder dystocia. She did a big episiotomy, cut almost down to the rectum, tried McRoberts’ position with the woman’s knees pulled back to her neck, tried the screw maneuver, even broke the baby’s clavicle to get him out, but nothing worked. Gorday was shit-ting bullets. Finally had to do the Zavanelli procedure.”

“The Zavanelli?” (All OB providers know about the Zavanelli. It’s a last resort: you flex the fetal head, push it back in the mother’s pelvis, and then do an emergency C-section.) “Did it work?” I ask.

Tom smiles. “Yeah, it worked. The baby was in intensive care for a few days, but he was all right. Now I understand Dr. Gorday’s fear.

I was never scared before, but I just want to get this last one over. I have a weird feeling.” The shadow of a hawk passes over the snow. I stand to look out the window but the raptor is gone.

By five on Sunday afternoon, Tom and I are sitting in an almost empty movie theater with a tub of popcorn and a Diet Pepsi.
Not much of a midwife,
I think,
watching a film instead of my patient,
but Jeannie was so totally comfortable after we’d placed the misopros-tol in her vagina, I couldn’t see the point of sticking around.

After dinner at our favorite Indian café and a short trip back to the birthing center, we go home to bed, fully expecting the nurse to call us in the middle of the night, but on Monday morning the sun rises and Jeannie’s mild contractions have petered out.

It is high time to get serious, only two more days to go. I do an amniotomy early and start IV Pitocin, recognizing, with some discomfort, that I’m messing with nature, just so we can be the ones to deliver our patient’s long-awaited baby. Then I settle down in the rocking chair to wait.

As the sun moves across the birthing room and shadows collect in the corners, Jeannie begins to moan. By six p.m., her uterine contractions are four minutes apart and moderate in strength, but her cervix is still only at three centimeters,
still
stiff and fibrous. Jeannie tries standing and swaying at the bedside, sits up in a chair, rocks on her hands and knees, but she’s getting weary. “I don’t care anymore about natural childbirth,” she snaps at her husband when he tries to get her to do her breathing. “I want an epidural.” No argument from Nathan. His wife’s been a trouper.

At midnight, we switch. Tom settles down for the night in the doctors’ call room, while I go home to our big king-size bed. Twice I wake and call the nurse for report, but at six in the morning I give up my effort to sleep and go back to the hospital.

When I walk into the pastel-wallpapered birthing room, Jeannie is snoring like an old man, poor thing; worn out. I nod to Tom, showered and dressed in clean blue scrubs, ready for the OR. “How dilated?” I whisper.

“Eight centimeters. I was up every few hours checking on her. The baby’s fine. Should be out by noon.” Always the optimist. I walk him to the doors of the surgical suite, where he’s scheduled to perform a laparoscopy and two tubals.

At nine a.m., I help Jeannie wash up and braid her long hair. “Will we have the baby today?” she asks, her face pale with fatigue.

“Yep.” (There are only fourteen hours until our OB privileges end. It
has
to be today.)

At eleven, Jeannie announces emphatically, “I need more pain medicine!” I glance at the monitor and pull on a sterile glove to check her cervix. “You don’t need more medicine.” I grin. “The baby’s right here, ready to be born. It’s time to push!”

So we push . . . And we push . . . For two hours, we push. It’s a group effort.

We try every position the nurse and I can think of. “Can’t we just do a C-section?” Nathan asks, eyeing the tracing as the fetal heart rate dips into the nineties, then bounces back to 150 again, a nice normal baseline. “Maybe he’s
too big.
” That thought has crossed my mind too, but it’s not time to give up yet.

“Come on, let’s go back to work. We’re missing some of these contractions. Here, Jeannie, pull on my hands. Pull!” An hour later, when Tom returns from the OR, he enters the birthing room as if he means business, and I’m glad to see him.

“How you doin’?” he asks Jeannie and shakes hands with Nathan. “Getting tired?” I catch his eye and glance toward the monitor. The decelerations are steeper now but always returning quickly to baseline.

Another big contraction and Jeannie grabs her butt then flops back in bed, trembling. “I don’t think I can do this!” After two days of labor and three hours of pushing, the young woman is spent. “Ready for some help?” Tom asks, slipping into a long green sterile gown. Terry, the RN, uncovers the delivery table and places a vacuum extractor, a modern alternative to forceps, near the corner. Clearly,
she
thinks it’s time.

“You bet I’m ready!” says Jeannie. “Is this finally gonna happen?” Though the extractor, which comes with a soft plastic suction cup, is less risky than metal forceps, it’s not without danger. It can cause bruising, laceration, a hematoma, or worse, a shoulder dystocia, like Dr. Gorday ran into, in which the baby’s head emerges

but the rest of the baby gets stuck.

Dr. Harman parts the labia. “This may hurt a little,” he warns as he applies the vacuum cup to the fetal head.

I center my attention. “Okay, Jeannie. Tom can’t pull the baby out by himself. That would be too much strain on the little neck. You’ve got to push as hard as you can and soon you’ll be holding your little one.”

But I’m wrong. Each time Dr. Harman pulls, the head moves only a quarter inch. Once, the vacuum slips off. Then again it slips off. And again. The head is crowning now, and, by protocol, the provider gets only three tries with the extractor; any more may cause damage. Tom lays the mechanical device aside, then sits on the stool between Jeannie’s legs, checking the vagina for stretch. Neither of us routinely does episiotomies—in fact, rarely, if ever— but I can tell he’s thinking about it. Nathan stares numbly at the top of his baby’s bruised head.

I reach over and pour a little oil, which the nurse has placed on the delivery table, over Tom’s fingers as he massages the vaginal opening; our gloved hands touch and he smiles. Our last delivery together. Shoulder to shoulder.

When the monitor shows a good contraction, I lean over the bed and whisper to Jeannie, “This is it, babe! One more push. You’re on your own now, no vacuum extractor. The head’s almost out.” With valor, the worn-out woman pulls back her legs once again. Nathan goes into position, holding her head, and I bend over, showing more optimism than I feel, to help Tom support the perineum.