It's a typical morning at the Partners in Women's Healthcare Clinic in Morgantown, W.Va., where Patsy Harman, nurse-midwife-OB/GYN practitioner, is already behind schedule.

Nila. Penny.

"I'm worried about how late I'm running and how many other women are waiting in the reception area," she says to herself.

Holly. Marissa. Rosa. Her nurse alerts her that patients are waiting.

"I'm now an hour behind."

Heather. Aran. Icy. Shina.

By the end of an eight-hour day, half of which is consumed with paperwork, Harman will have seen 20 women.

"There's something about the exam room that's like a confessional," Harman says. "I listen to what my patients tell me about their life, both sadness and joy, and I listen for what they don't say. I leave the exam room shaken and in awe by the very difficult situations women are in and the courage they have to have to march on. I think about all my patients who feel trapped by unhealthy relationships, financial burdens, or family troubles. They come into the office year after year, enduring the same old things, taking Paxil or Prozac so they can cope. Often I take their sadness home with me. In the stillest part of the deep night, I sit down to write. I need to sleepbut I need to tell their stories."

On Tuesday, Oct. 27, at 4 p.m. at The Country Bookshop in downtown Southern Pines, Harman will share those stories, as well as her own, when she presents, "The Blue Cotton Gown: A Midwife's Memoir."

"Their incredible tales represent a variety of age groups and common issues that women all over deal with: men troubles, kids' troubles, infertility, post-partum depression, drug abuse, domestic violence, poverty," Harman says. "It sounds like a real downer, but the thing is, most of these women triumph in the end, so really, 'The Blue Cotton Gown' is a book of hope."

In her review for Story Circle, novelist Susan Wittig Albert wrote, "Every story held me with its urgency, but the stories were sometimes so honest, so ruthlessly real, that I had to put the book down and look away -- and then come back, when I could breathe again."

Harman and her husband, Tom, an OB/GYN, set up their clinic in Morgantown, home of West Virginia University, in 1998.

"West Virginia has a reputation for being nearly the worst for everything in the U.S.," Harman says, "except for the beautiful scenery. We Mountaineers have the fourth highest poverty rate in the country."

The poverty level in Morgantown is 28 percent; the median income for women is $25,000.

"If a woman is poor enough, there isn't a problem getting a medical (Medicaid) card," Harman says. "It's the folks slightly above that line who get screwed, the working poor and the self-employed. If you're living on minimum wage, there's no way you can pay $700 for a family health-care policy."

In "Blue Cotton Gown," Harman shares the stories of Heather, 17, pregnant with twins, whose father is a drug addict; Nila, 38, a victim of spousal abuse who is expecting her eighth baby; and Marissa, 44, who is suffering from fibromyalgia and chronic fatigue syndrome. None of them has health insurance.

"It took years and a lot of tests and a lot of money to find out what was wrong," Marissa says. "I was married then and had insurance."

Rose, 34, a flight attendant on a corporate jet, had health insurance before she lost her job. Cindy, 50, a business owner, lost hers when she closed her interior design studio when the economy collapsed.

Self-described "airhead hippies" in the 1960s and '70s, Patsy and Tom Harman took out loans and returned to school -- he for his medical degree in OB/GYN from Ohio State, she for an RN and MSN in nurse-midwifery from the University of Minnesota in 1985.

After his residency, Tom Harman joined the faculty of the School of Medicine at WVU. They took out more loans to buy their first house and a cottage on Lake Erie, and to put their three sons through college. They borrowed another $200,000 to start up their private practice, and bore all the costs of expansion when they brought in a partner who within months took his patients and left.

"We never got back on our feet, never righted ourselves, never caught up," Harman says of that experience.

To compound matters, the couple discovered they owed the IRS $33,000 in back taxes due to incompetent accountants, and the IRS had their Medicaid payments withheld. During this stressful time, Harman had her own health problems -- first a gangrenous gallbladder and then uterine cancer, requiring an immediate hysterectomy. Dr. Harman was coping with malpractice threats, and the couple's 30-year marriage was suffering.

In 2003, medical liability insurance for obstetrics skyrocketed from $70,000 to $110,000 a year.

"You could buy a pretty good house in West Virginia for $110,000 -- a new one every 12 months," Harman says. "Over 75 percent of OB/GYNs have been sued. Soon nurse-midwives and nurse-practitioners will catch up with them. No matter how hard we try, Tom and I will face a lawsuit sooner or later. 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."

The Harmans gave up delivering babies.

"The cost of medical malpractice insurance remains too high in West Virginia," she says. "Things have changed very little, and our litigious culture is one of the reasons that health care in this country is so expensive."

Today, Harman still works with her husband at their clinic, although she no longer attends births. Now that she has more spare time, she is writing her next book, tentatively called "Broken Hallelujah: The Songs of a Hippie Earth Mama."

Patsy and Tom Harman have three sons and live on Cheat Lake in West Virginia.

For information, call The Country Bookshop at (910) 692-3211.