Elevate Difference

The Blue Cotton Gown: A Midwife’s Memoir

By the time Patricia Harman finished writing The Blue Cotton Gown, she was no longer working as a midwife. Instead, soaring malpractice fees had caused The Women’s Health Clinic of Torrington, West Virginia, a practice Harman runs with her husband, Dr. Tom Harman, to provide only general obstetrical and gynecological care to the patients it serves.

Harman is a nurse-practitioner and her memoir tracks a handful of women for approximately a year, zeroing in on the many variables that impact their health and well being: rampant drug and alcohol abuse, poverty, violence, mental illness, and inadequate information about staying healthy, among them. It’s a gripping account. At the same time, the book is as much a meditation on aging, marriage, and parenthood as it is a look at the obstacles and challenges endemic to the provision of healthcare in the U.S. This makes it both intensely moving and intensely, if obliquely, political.

Harman describes herself and her spouse as former hippies, people who found their professional calling in their thirties, after years of organic farming and communal living. Their countercultural impulses have made them compassionate, and their work is motivated by love of medicine, not love of the dollar. Not surprisingly, these tendencies have led to managerial problems. To whit, an inattention to finances—and way too much trust in accountants who could care less about the Harman’s ethos of providing the best care for the best price—led to monetary miscalculations that threatened to shutter the practice. When the IRS came calling, tensions built and the Harmans and their ten-person staff had to work tirelessly to forge a survival strategy. They did—the practice was saved—but not without both dents and dings to numerous personal relationships.

Meanwhile, they had patients to deal with and their own personal crises to address. Harman calls it “running in front of a plague of locusts.” There is Nila, pregnant for the eighth time, who fears that her ex-husband is molesting her four-year-old. There is Heather, a teenager pregnant by a nineteen-year-old drug addict, and Holly, a forty-five-year-old menopausal realtor whose bulimic daughter is perched on death’s window ledge. And there’s Rebba, worried because she has never had an orgasm, and Shiana, a college student who needs to have a condom extracted from behind her cervix.

Closer to home, the elderly parents of staff get sick and Harman, herself, becomes ill. Within the span of a few months she needs to have a gangrenous gall bladder removed and has a complete hysterectomy.

Throughout, there are constant money troubles—big ones—and the tension and stress are palpably presented. To her credit, Harman is not looking for either sympathy or accolades but her matter-of-fact descriptions of how difficult it is to provide high quality, patient-centered care is simultaneously enraging and shocking. While she never discusses the need for a national health plan—she also barely mentions abortion as an option for her oft-pregnant patients—her chronicle of the trials and tribulations of one nurse practitioner is riveting.

Yes, The Blue Cotton Gown could have been more politically prescriptive. Nonetheless, readers will find their immersion in the daily affairs of this off-the-beaten-track health center emotionally engaging, engrossing, and inspiring. Indeed, in an era of rampant medical discontent, the determination and persistence of Harman and her Torrington colleagues seems almost miraculous.

Written by: Eleanor J. Bader, June 17th 2009

We would LOVE to do this! I'll email you separately.

Eleanor, I'm a publicist for THE BLUE COTTON GOWN: A MIDWIFE'S MEMOIR -- (couldn't put it down when I reviewed it before taking on the assignment!) -- if you'd like we can provide a couple of signed copies of this book for your blog if that would be something your readers might like. Please email me at julie@jkscommunications.com if you'd like me to arrange this. Thanks for the great review! Patricia Harman and I LOVE this blog!

Thanks for a fine review, Eleanor, of what looks to be a fine book, written well; I'm going to get a copy and send it to one of my nurse-practitioner friends. I have worked in health services settings such that I empathize, to wit: widespread fears (and in a few celebrated cases, real events) that condoms will get "stuck" inside a vagina but, owing to rampant genitophobia, inability of Self or even Other to remove it until it's too late and gross infection sets in. The structural constraints on ailing systems is bad enough, but then you throw in gynophobia and genitophobia . . .

Patricia, keep fighting the good fight. The Harmans' ethos is one I and others support, and I could not care less what the accountants say. Lawrence Hammar

You've both made my day! Cheers, Eleanor

Eleanor writes the nicest reviews, and now I love the author too! So cool. I'm gonna pick this one up soon as I can. Sounds awesome.

Thank you for the very nice review, Eleanor. It is still very difficult to practice the kind of health care I would like in West Virginia. I am actually technically a nurse-midwife, but I practice as a nurse-practitioner as do many of the CNMs all over the country...we do everything but deliver the babies for various reasons. I started the Blue Cotton Gown about five years ago and intended to write about my patients, but the book turned out, as you say, to be an indictment of the medical system. If I had known that Health Care Reform was a possibility then, maybe I would have made the book more political. Still, I wanted you to know...I am with you on women having options on unintended pregnancies and for national health insurance. Be well, all. Patricia Harman, author of The Blue Cotton Gown.