A visiting nurse listens to Mathew’s chest a few weeks after the surgery. Back at home, Mathew’s 2-inch scar begins to heal.

Carrie Blanton parks her two-year-old sedan with its nose against a scraggly backyard tree and waits while her first-floor neighbor pulls her rusty Chevy behind it.

Carrie is desperate. She needs the car to get her sick baby to the doctors. She must avoid the clutches of the repo man as long as she can.

Her car securely blocked, Carrie reaches back to get the car seat holding three-month-old Mathew. His chest moves up and down as he struggles to breathe. She climbs the stairs to her second-floor apartment, lugging Mathew and his car seat with one hand.

“It’s a bad way to live,” she says.

The first time the repo man showed up at the house on Vose Street in Westerly, the Nissan Sentra wasn’t there. Carrie had driven to Providence to meet with Mathew’s cardiologist.

Soon after, the Virginia company hired to find Carrie started calling. She pleaded for more time. “My son needs surgery,” she told the man from Portfolio Recovery Associates. “He has two holes in his heart.”

Hiding from the repo man was the farthest thing from her mind in 2006 when Carrie Blanton picked out her first new car, traded in her gas-guzzler and signed a $20,000 loan. The shiny blue car gave her a sense of security. She had a good restaurant job and a husband to share the household expenses and the responsibility of raising their son, Tyler, who is bipolar.

But her husband, a Gulf War veteran and a carpenter, started drinking more and working less. By early last year, he was gone and the bills, including the rent and car payments, began to pile up.

During a rebound romance with a co-worker, Carrie got pregnant. Already living on the edge, the pregnancy changed her life in ways she never imagined.

The Carrie Blanton who splurged on the shiny blue car was employed and married. Two years later, she is a single mom, harried and broke.

In just a few months, Carrie, at 38, fell from self-sufficiency to poverty. “It happened so fast,” she says. Now, for survival, she depends on the government, churches and charities. Her days are often consumed doing the paperwork to get a few bucks for oil from one agency, several hundred dollars for food stamps from another.

In Washington County, she joins nearly 10,000 others living below the federal poverty line, 8 percent of the county’s population. After Providence County, sprawling Washington County –– known for its public golf courses, its sandy beaches and million-dollar homes –– has the second highest poverty rate for individuals in the state, according to Rhode Island’s Poverty Institute. And, census figures, last updated in 2006, don’t reflect the impact of the state’s current recession, rising unemployment and sky-high fuel and food costs. In Westerly, where Carrie Blanton lives, major employers –– Paragon, Bradford Dyeing, Darlington Fabrics and Agfa HealthCare Corp –– have moved or reduced operations, eliminating work for an estimated 400 people.

Social service agencies in Washington County are reeling. In 2006, the Bradford Jonnycake Center in Westerly gave out groceries for 48,000 meals. This year, the center expects that number to nearly triple. Demand for help with rents and utilities is also up.

“If you’re a single mom … you get overwhelmed,” says Sue Robinson, the caseworker at the Bradford Jonnycake Center, who assists Carrie. “Often, I ask people, ‘What kind of help do you need?’ They answer: ‘Everything’.”

Being poor in Washington County is different than in other parts of the state. Unlike the urban centers, resources are scattered and difficult to get to. “Transportation is a big problem,” says Jean Barry, executive director of a nonprofit group called Westerly Area Rest Meals. “People don’t go to doctors because there’s no bus.”

Rents are also higher in the southern part of the state. Last month, the Westerly homeless shelter received 86 calls for beds, Barry said. “Those numbers are unheard of. There are people living in campgrounds, they’re doubled up or they’re living in the woods. It’s scary.”

IT’S A HARD TRANSITION for Carrie, who left a foster home at 15 to work two jobs. She comes from a family of Polish immigrants and hard workers. Her grandmother packed toothpaste tubes in a factory until she was 80.

Carrie hangs a tiny vial on the rear view mirror of her hunted car. It contains the ashes of her mother, grandmother and grandfather. “They look out for me,” she says.

They weren’t always there for her in life.

When Carrie was 5, her mother tried to kill herself. She cut her wrists, stood in front of Carrie and said, “Do you see this? This is what men do to you.”

She doesn’t remember her father. But other memories are stark. One Christmas Eve, she says, her mother drank a bottle of bleach. Carrie, 9, woke up and called the police. A country music Christmas special played on the TV. Even today, Carrie cannot listen to Johnny Cash. Carrie was 14 when she, her sister and her brother were placed in separate foster homes in Connecticut. Soon after, their mother swallowed pills and suffered a massive stroke. One night Carrie’s foster mother woke her. “It was 4 a.m. She kicked me and said, ‘Your mother’s dead.’ She made me go to school the next day.”

Carrie moved out, landed a day job at Wendy’s and a night job selling shoes at Thom McAn. She rented an apartment in Norwich, next to a pizza joint. She walked to both jobs.

By 19, she was managing a Friendly’s Restaurant in Danbury.

“I grew up pretty quick,” she says.

Three years later, Carrie took time to finish her high school education. Along with a diploma, she got an award for “outstanding achievement and perseverance.”

In her mid 20s, she enrolled at a Connecticut technical school, planning to be a medical assistant. “I wanted to save lives,” she says. But the training centered on billing insurance companies. She dropped out.

Instead, over a 20-year span, she supported herself on tips and wages at Trader Jack’s, the Golden Dragon and other area restaurants as two husbands came and went.

But two months before Mathew was born, Carrie was in a bad way. She faced eviction from a rented house in Westerly, where she had lived for more than a decade. Christmas was near. She had $30.

Desperate, she drove to the Mother of Life Center, which provides assistance to pregnant teens and women. “I was ready to drive my car into a lake. They gave me hope,” Carrie remembers. They counseled her, and two staffers, moved by her plight, gave her a $100 food card as a personal gift. Two more agencies helped her move to Vose Street. A private donor provided a crib. A high school youth group and the W.A.R.M. shelter gave the family Christmas presents.

After Mathew was born in February, Carrie’s boss at the Koto Japanese Steak House in Groton asked her to come back to work, this time as a manager. Carrie needed the better job. But the doctors said Mathew would need constant care, at least in the first few years.

Carrie, who worked 12-hour shifts while pregnant, turned down the offer –– and joined the growing ranks of Washington County’s unemployed.

“When I’m working I feel in control. When I’m not, I feel trapped,” she confesses.

ONE MAY MORNING, Carrie scrambles to get Mathew to the doctors.

After hustling 8-year-old Tyler onto the school bus, she drives to Pier Cleaners where she tosses clothes into a washing machine. Juan sits in the car with the baby, staring at the rain. Juan is Mathew’s father. He drifts in and out of their lives.

Employed as a cook at a local restaurant, he wants to check out the job market in Los Angeles, where his sister lives.

Strapped in his car seat, Mathew struggles to breathe: Huhn, huhn, huhn. The clothes dried and folded — Juan doesn’t help — Carrie carries them to the car. She drives to the neighborhood school to give Tyler the medicine he forgot to take that morning.

Before heading north to Narragansett, Carrie pumps $10 worth of gas into her car. Even when she has the money, she doesn’t fill it because the repo man is on her trail. Now, she zooms along Route 1, on her way to Narragansett Bay Pediatrics. Dr. Joy Ziegler gives Mathew three childhood vaccinations in both thighs.

“Has he started to smile?” asks Dr. Ziegler.

“Yes,” says Carrie.

“Does he look you in the eye?”

“Yes.”

“Does he make cooing sounds?”

“Yes.”

Dr. Ziegler checks Mathew’s eyes and ears. She listens to his heart and feels his abdomen. “He’s a tough little cookie,” she says.

It’s the first good news since Mathew was born. Weighing just 6 pounds 8 ounces, Mathew started losing weight after two weeks. When he fell below six pounds his doctors prescribed a high-calorie formula.

Today he weighs 11 pounds, 1 ounce, and is 21½ inches long. That’s good, but he needs to gain more. Heart surgery is just six weeks away.

Juan, wearing a black sweatshirt and a backwards Yankees cap, shows Mathew his reflection in the mirror. “See, baby?” he says softly.

Carrie drops Juan off at the Venice Restaurant on Shore Road near Misquamicut Beach. She never eats there. She can’t afford it.

MATHEW’S SURGERY is scheduled for June 19 at Children’s Hospital in Boston. Carrie scrambles to find a place to stay so she can be nearby. But all of the houses for parents with sick children are full. “How much does it cost?” Carrie asks a social worker who suggests a place. “I’m really poor right now. I’m a single mom with two boys.”

Home is a two-bedroom, second-floor apartment on a dead end street. The backyard overlooks a chain link fence that borders the high school football field. Several months after she moved in, a chunk of the living room ceiling fell, weakened by a water leak. Bits of moldy debris fell on Carrie and the baby.

She keeps the apartment neat and comfortable. Images of lighthouses are everywhere, on the table tops, the curtains and the walls. In the paintings, clean white columns rise against pale skies and wispy clouds. Birds circle overhead. Carrie daydreams about living in one, where the only sounds are the waves smacking against rocks and sand.

No day is easy. Her $1,067 monthly income comes from $424 in cash assistance from the state and a $643 Social Security payment because of Tyler’s disability. Rent is $950. That leaves her with $117 a month to pay for electricity, oil, clothing, phone calls, cigarettes, laundry and gas for the car. “Every day I wonder, how am I going to make ends meet.”

She uses $420 a month in food stamps to feed herself and Tyler, and money from the federal WIC program to buy cheese, milk, formula and baby food. The state’s RIte Care program pays the family’s medical bills, and Juan buys diapers and helps with the rent and pays an occasional bill.

But it isn’t enough. When her food stamp money runs out, she grabs bags of food from the food pantry at the Immaculate Conception Parish on High Street, or the Bradford Jonnycake Center in the town’s north end.

At first, it bothered her to ask for food. No more.

CARRIE KNEW that her baby would have problems. Prenatal tests predicted Down syndrome.

More than one person, including her sister in Connecticut, asked her if she wanted to terminate her pregnancy.

Carrie said no.

“God,” she says, “only gives you what you can handle. He’s pushed me out of my comfort zone.” She pauses, then adds, “Mathew makes me happy, so it’s a good thing.”

It wasn’t always so.

At Westerly Hospital, after her delivery, Carrie did not want to see Mathew. A terrible picture formed in her mind.

She asked her downstairs friend, Heather Chase, to peek at Mathew in the nursery. “Heather came back and said, ‘He’s okay, Carrie. He looks fine.’ ”

When Carrie held Mathew for the first time, she saw his tiny hands and soft brown eyes, and fell in love. He looked like a little cashew.

Now, she is convinced he is the most beautiful baby in the world.

“Pookie,” she calls to him.

CARRIE WAS 21 when she met her first husband, a deli manager. After two daughters the marriage ended. Her husband moved to Missouri with their children. She keeps a picture of them on her apartment wall.

In 1998, she met her second husband. That marriage lasted longer, but fell apart when he started drinking.

Their son, Tyler, is a restless, chatty, spiky-haired boy who wears T-shirts with skulls on them and plays Grand Theft Auto on his Xbox 360. Jerking the controller, he shoots gang members and cops and steals their cars.

Carrie knows the game is for older boys, but what can she do? “All his friends have it.” Besides, she says, it’s better not to shield kids from the world. Restricted kids try everything, she says.

She was just the opposite. She had little guidance and few boundaries and doesn’t drink or take drugs, she says. Her vices are cigarettes –– she avoids smoking near the baby –– and Classic Coke.

Juan lives nearby. It’s a complex relationship. His appearances are sporadic, but he is always there on Thursdays, his day off. And, he often rides with Carrie on visits to Mathew’s doctors.

Serious and soft-spoken, his real name is Evelio Mondragon, but everyone calls him Juan. He grew up, he says, near a volcano in Mexico. A dutiful son, he sends money home to his mother.

Carrie started dating him last year, when they worked together in Connecticut. Juan, a sushi chef, initially wanted a family. But when she got pregnant, Juan “became a jerk,” she says. One night he showed up at her door, drunk. She called the police.

“He had to go to anger management class,” she says matter-of-factly.

On this day, Carrie urges Juan to postpone his trip to L.A. so he can be around for Mathew’s surgery. “Yes, it’s a dangerous operation, and anything can happen,” she says. “But running away isn’t the way to deal with it.”

Juan leaves for California anyway. He returns after a short time. “Too hot,” he says.

One morning Juan watches the baby in the living room. He wears jeans, a white Puma T-shirt and white tennis shoes. Mathew squirms in a blue jumpsuit with a Boston Red Sox logo.

Carrie, in flip flops and a sweatshirt, sits on the couch. Strands of her blond hair, pulled back from her face, break away and dangle in front of her face. She looks tired.

The TV is on. A woman on NBC’s Today show gets a “complete makeover” and appears on the set with “sexy bangs,” a new hair color and a Diane von Furstenberg dress. Later, Martha Stewart shows her viewers the proper way to cut a piece of pie.

IN HER APARTMENT, Carrie keeps medical books and pamphlets. Some have hopeful titles. “You Will Dream New Dreams,” says one.

Others are jammed with facts.

One in every 733 babies is born with Down syndrome.

When a genetic counselor first told her that her son would have Down syndrome, she yelled, “You’re wrong!” The lab tests said otherwise. Instead of 46 chromosomes — 23 from the mother and 23 from the father — Mathew would have 47. Down syndrome often brings problems, from heart trouble and poor hearing to leukemia and retardation.

Some of this is explained in A Parent’s Guide to Down Syndrome: Toward a Brighter Future, by Siegfried M. Pueschel, the director of child development at Rhode Island Hospital.

Parents often ask, “How did it happen?” and “What have I done?” writes Pueschel. “To this point, however, no satisfactory answers have been found.”

MATHEW GROWS stronger on his mother’s love, mushy potatoes, grape juice and Lasix, a diuretic to help his kidney work properly. He gains weight.

Still, Carrie frets. With the operation getting closer, she still has no place to stay. Is this a sign Mathew shouldn’t have the operation now? she wonders.

At a Wal-Mart store, a woman stares at Mathew.

“Is he Downs?” the woman asks.

“No,” says Carrie. “He’s Mathew. He has Downs.”

Two weeks before the surgery, Carrie puts $10 worth of gas into her Sentra. The ashes of her guardians –– her mother and grandparents –– still hang from her mirror. “They’re one of the reasons my car hasn’t been taken.”

Back in the Narragansett Bay Pediatrics exam room, Tyler fidgets and thumps his mother’s leg while the nurse stretches the baby out on a table.

“He’s breathing kind of fast,” says Dr. Ziegler. “How much has he eaten in the last 34 hours?”

“He’s drinking 18 to 20 ounces of formula a day,” Carrie says.

“How’s his mood?”

“Kind of cranky,” says Carrie.

“I’m a little worried about that.”

Ziegler holds the baby and rubs his back. Mathew wears a yellow outfit that says “Precious Cargo.”

“He doesn’t look as good as he did before,” she says.

Tyler squeezes his mother’s shoulder. Carrie looks into Mathew’s eyes. “Why do you have to scare Mommy all the time?”

Dr. Ziegler urges them to go directly to Hasbro Children’s Hospital, where her husband is chief of the cardiology department.

After they arrive in Providence, Carrie and Tyler watch as a technician pushes a probe across Mathew’s chest.

Dr. James Ziegler is impressed with Mathew’s weight gain. “He’s been the star patient in our eyes,” he says. “We may ask you to write guidebooks on how to make children with heart diseases grow.”

Carrie smiles.

Dr. Ziegler places a stethoscope on Mathew’s chest. Although his breathing is heavy, “I’m not worried that his lungs are falling apart.”

The baby is ready for surgery.

Mathew kicks and waves a tiny fist as the doctor looks him over.

“He’s fighting me,” Ziegler says.

“That’s because I’m his mother,” says Carrie. “We’re feisty.”

AT THE LAST MINUTE, RIte Care, the state-run health plan, agrees to provide a car and driver to take Carrie, Juan and Mathew to Boston. At 4:30 a.m. they climb into the back seat and ride to the hospital.

Mathew undergoes a series of exams: chest x-rays, another echocardiogram. When a nurse draws blood, and it spurts on the sheet, Carrie tenses; Juan folds his arms around her.

Later in the day a doctor recommends that surgery be postponed until Mathew is older.

Carrie, who has readied herself for the operation, snaps at her.

The surgeon, Dr. Pedro del Nido, reviews the tests and says the surgery can go forward the next morning.

Carrie, Juan and the baby return home to Westerly, exhausted. After a few hours of sleep, they grab another ride to Boston.

When a nurse takes Mathew from her arms, Carrie cries.

During the four-hour operation, she and Juan wait on a couch in a chilly third-floor room. On a TV on one wall, the Boston Celtics celebrate their NBA championship. MVP star Paul Pierce smokes a big cigar. Everywhere, fans wave and shout and wear green wigs.

Carrie curls up on the couch, her head in Juan’s lap. Juan falls asleep sitting up.

Around 12:30 p.m., the surgeon appears, still in his scrubs. The operation was a success, he says.

CARRIE SPENDS THE week at the hospital, sleeping on a vinyl chair. On June 24, her birthday, Mathew’s lung collapses, but he recovers.

Back at home, Mathew’s 2-inch scar begins to heal.

Carrie talks about going to college to become a nurse. She also considers a new waitressing job, anything that will help her get back on her feet.

It won’t be easy. With every lurch forward, there’s a setback.

She gets a much-needed boost when the Westerly Housing Authority agrees to help pay most of her rent. Later, the state says it will reduce her food stamps to $54 a month because of the housing subsidy.

At 2:36 a.m. one morning, she jerks awake. The phone is ringing. A man from Massachusetts is downstairs, joined by a police officer. He is there to take her car.

Carrie rushes out the door. She grabs the base of Mathew’s car seat, her registration papers and, at the last minute, the vial containing the ashes of her mother and grandparents.

First-floor neighbor Heather Chase reluctantly moves her car, freeing the Nissan Sentra. She yells at the repo man, but it does no good. He guides Carrie’s car onto a flatbed trailer and drives away.

pdavis@projo.com