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.

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