Wednesday, February 11, 2009

Q and A with author Patricia Harman

The Blue Cotton Gown: A Midwife's Memoir

Patricia Harman, a nurse-midwife, manages a women’s health clinic with her husband, Tom, an ob-gyn, in West Virginia—a practice where patients open their hearts, where they find care and sometimes refuge. Patsy’s memoir juxtaposes the tales of these women with her own story of keeping a small medical practice solvent and coping with personal challenges. Her patients range from Appalachian mothers who haven’t had the opportunity to attend secondary school to Ph.D.’s on cell phones. They come to Patsy’s small, windowless exam room and sit covered only by blue cotton gowns, and their infinitely varied stories are in equal parts heartbreaking and uplifting. The nurse-midwife tells of their lives over the course of a year and a quarter, a time when her outwardly successful practice is in deep financial trouble, when she is coping with malpractice threats, confronting her own serious medical problems, and fearing that her thirty-year marriage may be on the verge of collapse.

Why did you write this book?

I've always been so impressed with the courage of the ordinary women. Patients of all walks of life come into my exam room and I ask them, "So how are you doing? How's your stress level? At first they may make a joke about it."

"Oh, terrible, but isn't everyone's…." But then I draw my rolling exam stool forward and they tell me their stories. I leave the exam room shaken and in awe by the very difficult situations women are in and the courage they have to have just to march on. Since I had insomnia, I began to get up at night and write down their stories. I felt there was something majestic about them. These women, with all their imperfections, are like all of us, and they're my heroes."

Who is The Blue Cotton Gown written for?

I wrote the Blue Cotton Gown primarily for other women, but the men that have picked it up have been fascinated. That's partly because one of the male protagonist is my husband, a mild mannered physician, who like the women in the stories has his own troubles. I think, in addition to women of all ages, the book is interesting to health care providers because it illuminates some of the difficulties of trying to maintain a private practice in the midst of a health care system in crisis.

Did it concern you that you might say more about your patients than they would want you to?

I went to great lengths to disguise each patient. If you were an Asian Teacher I'd make you a Hispanic Bank President. I also let each major patient read her own chapters to see if she wanted them to be in the book, or if she wanted me to change anything. Not one said no. One women spoke for them all when she told me, 'If my story can help another woman not feel alone, I want it to be in there.'

Of all the many problems that women have, and that you address in the book, what strikes you as the most difficult?

Women carry great burdens, often in silence. When I ask patients about their stress level, most of the time it is a 9 or 10. This is not good for their health. I am also concerned that women have so little support and feel alone. All this affects their health. Women take care of everyone else and themselves last. How did you decide which women to write about? I chose women who came back to the office several times over the course of a year and women of all ages so there's someone in The Blue Cotton Gown that every reader can relate to.

Most people think of nurse-midwives as providers that deliver babies, but you're taking care of women who aren't pregnant, is that unusual for a midwife?

Traditionally midwives did only deliver babies and give care in the prenatal and postnatal period but more and more women see their nurse-midwives for gyn because they appreciate the respectful, gentle and holistic approach they provide. I have patients that are 10 and patients that are 80.

The book has a lot of information about you and your family. How did your husband, Dr. Harman, and your sons feel about this?

My husband Tom is my partner and back-up physician in our practice. I didn't start out to write about myself, or the practice, the health care system or our marriage and family, but it turned out to be an integral part of the Blue Cotton Gown. Our story is interwoven with the stories of patients. Tom and my boys were incredibly generous in letting me write about our difficulties and our love. I guess we all believe that honesty is the best policy and that people can learn from other's experiences.

What's been the most rewarding thing about writing and getting The Blue Cotton Gown published?

The letters from readers. The Blue Cotton Gown celebrates the courage of the ordinary women and all professionals who struggles to survive with their souls intact. I get emails every day from readers who are touched by the book. It makes a difference to their lives.

Patricia Harman has spent over thirty years caring for women as a midwife, first as a lay-midwife, delivering babies in cabins and on communal farms in West Virginia, and later as a nurse-midwife in teaching hospitals and in a community hospital birthing center. Visit her at

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