The Midwife Trilogy (13 page)

All these photos David showed me during the two days of watching. When I first met him I’d assumed he must be her father. But no, he was her husband and lover, and worshipped the very ground beneath her feet. He was a scientist, and looked a very reserved, controlled, unapproachable sort of man, perhaps even cold and unemotional. But still waters run deep, and over those two long days the intensity of his passion and pain nearly split the hospital apart. Sometimes he was talking to her, sometimes to himself, occasionally to the staff. Sometimes he muttered prayers, or a few words forced out through sobbing tears. From these fragments, and the case history, I pieced together their story. There was nothing of the cold remote scientist about David.

They had met at a music club, at which Margaret was performing. He couldn’t take his eyes off her. All through the interval, and the social afterwards, he followed her every movement with his eyes. He thought he might speak to her, but stammered and couldn’t get the words out. He couldn’t understand why; he was an articulate man. He did not know what was happening to him. She continued laughing and talking with other people while he retreated to a corner, scarcely able to breathe for the beating of his heart.

In the following days and weeks, he couldn’t get her out of his head. Still he didn’t understand. He thought it was the music that had affected him so deeply. He felt restless and ill at ease and his comfortable bachelor habits afforded him no comfort. Then he bumped into her in a Lyons Corner House, and amazingly she remembered him, though he couldn’t think why. They had lunch together, and this time, far from being tongue-tied, he couldn’t stop talking. In fact they talked for hours. They had a thousand things to say to each other, and he had never felt so relaxed and happy with anyone in all his forty-nine years of fairly solitary life. He thought, She can’t possibly be interested in a dried-up old fogey like me, smelling of formaldehyde and surgical spirits. But she was. Perhaps she saw the integrity, the spiritual strength and the depths of untapped emotion in that quiet man. She was his first and only love, and he lavished on her all the passion of youth, with the tenderness and consideration of maturity.

Afterwards he said to me, “I am just thankful that I knew her at all. If we had not met, or if we had met and just passed each other by, all the great literature of the world, all the poets, all the great love stories would have been meaningless to me. You cannot understand what you have not experienced.”

They had been married for six months, and she was six months pregnant, when she was admitted to the antenatal ward of the City of London Maternity Hospital where I was working. According to her antenatal records, Margaret had been in perfect health throughout the pregnancy. She had been seen at the clinic two days earlier, and everything had been quite normal - weight, pulse, blood pressure, urine sample, no sickness - nothing that would indicate what was to come.

On the day of admission she had awoken early, and was sick, which was unusual as morning sickness had passed about eight weeks earlier. She returned to the bedroom, saying there were spots in front of her eyes. David was concerned, but she said she would lie down again. It was a bit of a headache, and would go if she had another sleep. So off he went to work, saying he would telephone at eleven o’clock, to see how she felt. The telephone rang and rang. He imagined he could hear it echoing through the empty house. She might be out, of course, having woken up refreshed, but a premonition told him to go home.

He found her unconscious on the bedroom floor, with blood smeared all around her mouth, across her cheek, and in her hair. His first thought was that there had been a burglary, during which she had been attacked, but the total absence of any signs of a break-in, and the apparent depth of unconsciousness, the stertorous breathing, the bounding heartbeat that he could feel through her night dress, told him that something serious had happened.

The hospital sent an ambulance straight away, in response to his frantic phone call. A doctor came also, as the implications of David’s description were very grave. Margaret was sedated with morphine before the ambulance men were allowed to move her.

We were told to prepare a side-ward to receive a possible case of eclampsia. It was during my first six months of midwifery training, and the ward sister showed me and another student how this should be done. The bed was pushed against the wall, with pillows stuffed down the crack. The head of the bed was padded with more pillows and secured tightly with sheets. Oxygen was brought in: a mouth wedge and airway tube were in readiness, also suction apparatus. The window was covered with a dark cloth to black out most of the light.

Margaret was deeply unconscious on admission. Her blood pressure was so high that the systolic was over 200 and diastolic 190. Her temperature was 104 degrees Fahrenheit and her pulse was 140. A catheter specimen of urine was obtained and tested. So heavy was the deposit of albumen that upon boiling the urine turned solid like the white of an egg. There was no doubt of the diagnosis.

Eclampsia was, and still is, a rare and mysterious condition of pregnancy, with no known cause. Usually there are warning signs before onset known as pre-eclampsia, which responds to treatment, but if untreated may progress to eclampsia. Rarely, very rarely, it occurs with no warning in a perfectly healthy woman, and in the space of a few hours it can develop to convulsion stage. When this stage is reached, the pregnancy is unstable, and the foetus unlikely to survive. The only treatment is immediate delivery of the baby by Caesarean section.

Theatre had been alerted and was ready to receive Margaret. The baby was dead on delivery, and Margaret returned to the ward. She never regained consciousness. She was kept under heavy sedation in a darkened room, but even then she had repeated convulsions that were terrifying to see. A slight twitching was followed by vigorous contractions of all the muscles of the body. Her whole body became rigid, and the muscular spasm bent her body backwards, so that for about twenty seconds only her head and heels rested on the bed. Respiration ceased, and she became blue with asphyxia. Quite quickly, the rigidity passed, followed by violent convulsive movements and spasms of all her limbs. It was hard to keep her from hurling herself on to the floor, and quite impossible to keep a tongue wedge in place. With the violent movements of the jaw she bit her tongue to pieces. She salivated profusely, and foamed at the mouth, which mingled with the blood from her lacerated tongue. Her face was congested and horribly distorted. Then the convulsion subsided, and a deep coma would follow, lasting for an hour or so and followed by another convulsion.

These terrible fits occured repeatedly for a little over thirty-six hours, and on the evening of the second day, she died in her husband’s arms.

All this flooded into my mind in the few seconds that I stood at the sink, looking at the sample of Sally’s urine. David. What had happened to that poor man? He had staggered out of the hospital half blind, half mad, dumb with shock and grief. Sadly, in nursing, and particularly in hospital nursing, you meet people during some of the most profound moments in their lives, and then they are gone from you for ever. There was no way that David would be hanging around the maternity hospital where his wife had died, just to reassure the nurses. And equally, hospital staff could not go chasing after him to find out how he was coping. I remembered with gratitude what he said to me just after she died, and the words of some great writer (I cannot recall who), came to mind:

He who loves knows it. He who loves not, knows it not.

I pity him, and make him no answer.

There was no time to mope. I had to see Sister and report on Sally’s condition.

Sister Bernadette was in charge on that day. She listened to my report, looked at the urine sample, and said, “There may be contamination from a vaginal discharge, so we will take a catheter specimen of urine. Could you just get things ready for catheterisation, please, while I go over to Sally and examine her.”

When I took the tray over to the couch Sister had already made a full examination, and confirmed everything I had reported.

She said to Sally, “We are going to insert a small tube into your bladder to drain off some urine for testing in path. lab.”

Sally protested, but eventually submitted, and I catheterised her. Then Sister said to her, “We think there is a problem with this pregnancy that requires absolute rest, and a special diet, and certain drugs to be administered daily. For this, you must go to hospital.”

Sally and her mother were alarmed.

“What’s up? I feels all right. Just a bit of a headache, that’s all.”

Her mother butted in, “If there’s anything wrong with our Sal I can look after ’er. She can take it easy at home, like.”

Sister was very firm. “It’s not just a question of taking it easy and staying in bed some of the time. Sally has to have absolute bed rest, twenty-four hours a day, for the next four to six weeks. She will have to have a special no-salt diet, with low fluid intake. She will need to have certain sedative drugs four times a day. She will need to be watched carefully, and her pulse, temperature and blood pressure will have to be taken several times every day. The baby’s progress will also have to be checked daily. You cannot possibly do all this at home. Sally needs immediate hospital treatment, and if she does not get it, the baby will be at risk, and also the health of the mother.”

This was a very long speech for Sister Bernadette, who was usually very quiet. It was absolutely effective, though, for it silenced Sally’s mum, who gave a squeak, and said nothing.

“I am going now to ring the doctor, to ask him if he can find a bed for you immediately at one of the maternity hospitals. I want you to stay where you are, lying quietly on the couch. I don’t want you to go home.”

Then she said to Enid: “Perhaps you would go home and get some things for Sally in hospital - nightdresses, toothbrush, things like that, and bring them back here.”

Enid scurried off, glad of something to do.

Sally had a couple of hours to wait before an ambulance came, and she was taken into this in a wheel chair. I think she was bewildered by all the fuss and the attention she was getting, especially as she didn’t feel ill, had walked to the clinic, and was quite capable of walking out.

Sally was taken to The London Hospital in Mile End Road. She was admitted to the antenatal ward, where there were ten to twelve other young women in just the same stage and condition of pregnancy as herself. She received complete bed-rest, even to the extent of being pushed to the toilet in a wheel chair. She was sedated, and given a specific diet and low fluid intake. Over the next four weeks her blood pressure gradually came down, the oedema subsided, and the headache passed. At thirty-eight weeks of pregnancy, labour was induced. Sally’s blood pressure began to rise during the labour, so as soon as she was fully dilated, she was given a light anaesthetic, and a fine healthy baby was delivered by forceps.

Mother and baby both remained well during the post-natal period.

Eclampsia is as much a mystery today as it was fifty years ago. It was, and still is, thought to be caused by some defect in the placenta. But nothing has been proven, even though thousands of placentas must have been examined by researchers attempting to isolate this supposed “defect”.

Sally’s case was typical of pre-eclampsia. Had she not been diagnosed, and received prompt and expert treatment, her condition could have led to eclampsia. But the simple treatment that I have described - total rest and sedation - may have averted its development.

Margaret, who died in that ghastly way, had a very rare onset of sudden, violent eclampsia, with no warning signs, and no preeclamptic phase. I have never seen another such case, but they do still occur occasionally.

Pre-eclampsia and eclampsia are still leading causes of maternal and perinatal mortality in the UK, in spite of modern antenatal care. What befell the women with pre-eclampsia when there was no antenatal care? It does not take a great deal of imagination to answer that one. Yet doctors who advocated the study of and provision for proper antenatal care were regarded, one hundred years ago, as eccentrics and time-wasters. The same attitude poured scorn on the idea of a structured and regulated training for midwives.

Let those of us who have borne children thank God that those days are now past.

FRED

A convent is essentially a female establishment. However, of necessity, the male of the species cannot be excluded entirely. Fred was the boiler-man and odd-jobber of Nonnatus House. He was typical of the Cockney of his day and age. Stunted growth, short bowed legs, powerful hairy arms, pugnacious, obstinate, resourceful; all these attributes were combined with endless chat and irrepressible good humour. His most striking characteristic was a spectacular squint. One eye was permanently directed north-east, whilst the other roved in a south-westerly direction. If you add to this the single yellow tooth jutting from his upper jaw, which he generally held over his lower lip and sucked, you would not say he was a beautiful specimen of manhood. However, so delightful was his optimism, good humour and artless self-confidence that the Sisters held him in great affection, and leaned on him heavily for all practical matters. Sister Julienne had a particularly strong line in helpless feminine appeal, “Oh Fred, the window in the upper bathroom won’t close. I’ve tried and tried, but it’s no use. Do you think ...? If you can find time, that is ...?”