Hard Pushed
Page 14
‘I’m here to pick up a patient,’ he said. He took a folded scrap of paper from his pocket – smaller and less worn than Pei Hsuan’s – and squinted at it as he attempted to read her name. ‘Pay Shoon, it says here. Or something like that.’ He flashed a quick smile at me. ‘Be a sweetheart and be quick about it, if you don’t mind. I’ve got another three to collect before I clock off, and the traffic’s a bloody nightmare.’
I didn’t feel like being quick about it, and after the day I’d had, I certainly didn’t feel like being a sweetheart. Not for this man, not for anyone. But what choice did I have? I couldn’t head home that night without knowing that I had done my best to find Pei Hsuan her own accommodation, however basic, and I couldn’t refuse to hand her over to the driver on the very thin grounds that he was a man. Did he seem trustworthy? I couldn’t tell. Did he seem pleasant? It was a moot point. I couldn’t even ask him for any further proof of his identity or legitimacy; he had shown me his ID straight away, exactly as protocol dictated.
‘Is that your girl’s lift, Hazard?’ Betty asked as she passed the desk. ‘About time. She’ll be better off out of this madhouse,’ she said, nodding towards the side room. ‘She’ll be in there, wishing she’d never come.’
I raised a weak smile in reply as the driver shifted impatiently from foot to foot. ‘Come with me,’ I said.
Pei Hsuan was sleeping, her tiny body curled into a ball, her bare feet overlapping like the wings of a bird. She was alone. May had left at two o’clock, called to another interpreting job in a different part of the hospital. She’d heard many stories, and would hear many more, all different, all urgent, but each one filtered by her from mother tongue to English, the language of the system.
‘Pei Hsuan,’ I whispered, rousing her as gently as I could. Her eyes snapped open, and her gaze darted from me to the man whose unfamiliar bulk filled the door frame behind me. ‘This man will take you to your home for the night.’ Inwardly, I cursed myself for speaking loudly and slowly, as if to a child. Idiot, I told myself. She’s got no idea what you’re saying. I couldn’t even use my phone to translate; the battery had died hours ago. Instead, I smiled awkwardly and gestured to the driver, who winked and raised his hand to his forehead, pretending to doff an invisible cap. Pei Hsuan drew herself slowly up to sitting, and slipped her feet into the flip-flops on the floor, but she seemed glued to the bed by inertia, or terror, or both.
‘Please, Pei Hsuan,’ I said, trying to mask the desperation in my voice, and hoping that she would at least understand my best intentions. ‘He will take you to a safe place. Please.’ I guided her towards the door with heavy feet. The corners of my mouth were smiling, but my cheeks were frozen.
‘All right, love,’ the driver chirped to Pei Hsuan as he turned to leave. And then, over his shoulder, with another wink, ‘As they say, chop-chop!’
He marched into the waiting room and strode towards the exit. Pei Hsuan took one last, long look at me, surveying me coolly from top to toe. What did she see? A kindly stranger with goodwill in her heart, or another link in the chain, passing her thoughtlessly into the waiting hands of another man, who would take her to another crowded flat, packed to the rafters with another tragic gaggle of lost and lonely girls? Pei Hsuan’s expression was inscrutable. After a moment that seemed to hold a lifetime of disappointment, she turned her head and body as one, and with a slow, shuffling gait, she followed the driver out of the department, her flip-flops scuffing the floor as she went.
Notes on Baby Brain
There was a magical moment somewhere towards the end of my second pregnancy when I found myself in the kitchen late at night, standing in the glow of the open refrigerator, cradling a toaster in my arms. Having made myself a slice of buttery toast, I had unplugged the toaster, carefully coiled its cord around its still-warm body and opened the fridge. I was moments away from placing the toaster on the middle shelf in between a tub of hummus and a half-eaten chocolate cake. I had performed this sequence of movements fluidly, unquestioningly, as if unplugging one’s toaster and storing it in the fridge was the most natural and logical thing to do. At the last second, some distant spark of common sense fired in my brain and I realised that perhaps the toaster really ought to remain in its usual nest of crumbs on the worktop. Ah, I thought to myself, surveying the contents of the fridge as if I’d suddenly awoken from a sleepwalking episode. Baby brain.
I was amused – and maybe even a little bit proud – to find myself suddenly victim to one of the most widely known foibles of modern pregnancy. To suffer from ‘baby brain’ – whether late at night, in front of the fridge with a toaster in your arms, or in the supermarket, wondering what on earth you came in for – is almost a rite of passage. It’s a sign that yes, while your body has shown the outward signs of pregnancy for a while, your mind has finally followed suit in universally accepted, frazzled fashion – like a modern version of ‘hysteria’, the archaic, catch-all term once used to describe any kind of female behaviour which deviated inconveniently from the norm. In the good old days of shit-and-sawdust asylums and psychological quackery, a diagnosis of hysteria (a word whose Greek translation means, quite literally, ‘a condition of the womb’) could easily damn a woman to a lifetime of brutal and humiliating abuse disguised as ‘treatment’. While hysteria is, thankfully, no longer recognised as a legitimate psychological ailment, could it be that ‘baby brain’ is its harmless-sounding, more socially acceptable descendant? We may no longer lock women up for being strange or silly, but there still seems to be a need to pathologise – and find quaint, cosy nicknames for – the normal flux of the female psyche.
Even the most progressive contemporary psychologists and neuroscientists have yet to reach a consensus on what actually happens to a woman’s brain during pregnancy and early parenthood. Does she get stupid or smart? Does she become more introverted and oblivious to the world around her as she focuses on her baby? Or is she more switched on to the emotional and physical cues of those closest to her, thus giving her an evolutionary advantage as she attempts to bond with, and care for, her offspring? In spite of copious research, no one seems able to say with any certainty what happens inside the weird and wonderful brain of a woman as she makes the transition to motherhood. Like Mel Gibson puzzling over the opposite sex in the now amusingly dated film What Women Want, much of modern science seems to look at pregnant women, scratch its head and drag its knuckles onwards down the laboratory corridor.
What is clear, though, is that perinatal mental health is becoming a hot topic and an urgent cause for concern. There is a growing body of international evidence around the subject, with studies of varying focus and intent arriving at the same conclusion: the emotional toll of early motherhood is more pervasive and complex than has previously been thought. Recent evidence from the UK suggests that as many as one in five women experience problems with their mental health during pregnancy and the first year after birth. To put that statistic in context, this means that in some areas, the odds of a woman experiencing poor perinatal mental health are higher than her odds of having a forceps birth, and almost as high as her baby being delivered by Caesarean section – and these are only the women we know about. In addition to those who are sick enough and/or brave enough to seek help with their mental health and to receive a diagnosis of depression, anxiety or even postnatal psychosis, I can say from experience that there must be thousands, even millions of women, around the world who struggle with the massive physical and emotional challenges of pregnancy and parenthood without admitting these difficulties to a single soul. If you cry every day for the first month after your baby is born, wondering what you’ve done with your life, does that mean you have an ‘adjustment disorder’? If you spend hours scrolling through your Instagram feed, hoping to find just one other photograph of a pregnant woman whose skin is as spotty and ankles as swollen as yours, does that mean you’ve developed body dysmorphia, or an Internet addiction, or both? Are your struggles pathological, or normal, or some t
horny combination of the two? And if these issues are so common, then why are so many books and websites fixated with which kind of fruit your gestating fetus most closely resembles, rather than the more salient question of what might be going on with your brain as the months tick by? It’s all very well to know that your baby is the size of a pomegranate, but when you can’t pull your leggings over your bump without being overcome by a crushing sense of impending doom, any grocery-related niceties pale into insignificance.
In our privileged position at the sharp end of women’s hopes and fears, we midwives are well placed to estimate the true extent of women’s psychological struggles during the childbearing year. And I can say with absolute certainty that these challenges are poorly served by the nebulous diagnosis of ‘baby brain’. That woman in your office who always has the chicest maternity clothes might be the same woman who phoned me at 2 a.m., choking out enough words to convey that she was in the grips of a terrifying panic attack – her third that week. The bolshy pregnant teenager who pushed past you at the bus stop yesterday might be the very one who appeared unannounced in Triage in the wee hours of the morning, face covered in snot and tears, begging for a bed because she was afraid of what she would do to herself if she stayed at home for a minute longer. Under that hoodie are rows of wounds razored neatly into her arms; some still raw, some already tough with silver scar tissue.
Of course, not all cases of modern-day ‘baby brain’ are apparent to the average observer. Some women excel at carrying secret wounds while smiling serenely at the world, but a skilled midwife can find what is hidden. She can listen, she can believe, and on the right day, she can heal.
Jaspreet: Too Many Hours in the Day
I just couldn’t work it out. Like so many of the women who end up in Triage – appearing at the desk immaculately groomed and smiling, in spite of having phoned in tears only hours before – I was beginning to wonder whether Jaspreet was one of the countless ‘worried well’ who keep us in such brisk business. It’s not unusual for midwives to quip that a patient has been ‘miraculously cured’ simply by the act of arriving at the hospital. Abdominal pain that failed to respond to truckloads of paracetamol suddenly vanishes before the patient’s bottom has even hit a bed; throbbing headaches mysteriously cease amid the chaotic din of the waiting room. The genuinely ill women arrive sick and stay sick until treatment is initiated, but for so many others, inhaling the hospital’s heady whiff of sympathy and disinfectant seems to provide a fast fix. The more cynical among us might regard these women with a hefty dose of side-eye, and the oft-uttered assessment, ‘She’s at it.’ The softer among us might surmise that for so many women, the maternity hospital is a place where they know they will be listened to, and heard, and held in a safe space for an hour or an afternoon. This alone is sometimes enough to soothe and heal before the consultation has even begun.
Jaspreet – or ‘Jas’, as she introduced herself – had phoned the department at three o’clock on a steady day shift, when the after-lunch slump had begun to slow my step and blunt my thoughts. The morning had been awash with women whose waters had broken during the previous night’s full moon, and by the afternoon my hand actually ached from doing so many examinations. Some of these patients had been admitted to the antenatal ward, some had been rushed round to labour ward, and a disgruntled few had been sent back home ‘to establish’, as we call it – in other words, to soak through a few packs of maternity pads and wait for the pain to come. By the time Jas called, I was a little punch-drunk from the day’s workload. I had collapsed into a chair by the desk, hoping for a moment’s reprieve, but the phone lit up as if on cue.
‘Triage, Midwife Hazard speaking, how can I help you?’ I trilled automatically.
‘Well, what it is, is … I had my baby eighteen days ago and I feel tired all the time.’
I sat back and flicked my pen across the desk in jaded resignation. Of course you’re bloody tired all the time, I wanted to say. You can probably count on one hand the hours of solid sleep you’ve had since delivery, your rigid, swollen breasts are leaching every last ounce of your energy into the baby in your arms, your vagina may well be a road map of hastily sutured highways and byways, and you’re wondering whether your life will ever be normal again. Of course you’re tired, my love – how could you not be?
‘So, you feel tired all the time?’ I enquired coolly in my best telephone voice, with exactly the right modulation of gentle concern. Mirror the patient, we’re taught. Repeat back what she’s told you, so she feels listened to, even if she’s just confided that her labia look like rotten pork (true story).
‘I’m exhausted,’ said the voice down the line, ‘no matter how many naps I get, or what I eat, or what I do. And my Caesarean scar is getting more and more painful every day.’
Now she had my full attention. Fatigue is hardly front-page news in a maternity hospital – for patients and staff alike – but a wound that fails to heal with good hygiene and the passage of time can indicate an infection.
‘Does the area look inflamed?’ I asked. ‘Can you see any gaping along the line of your wound, or any blood or fluid leaking out?’
‘I don’t know. I’ve been scared to have a closer look.’
It never ceases to amaze me how many women are afraid of examining their own bodies in a medical context. We spend enough time finding fault with our thighs, arms, eyebrows or any other feature that doesn’t quite match up to modern beauty standards, but when it comes to lumps, bumps and issues of a more intimate nature, too many of us shy away from any serious scrutiny. Even the caller who says, ‘There’s something coming out of my vagina,’ often balks at the suggestion to go and have a keek in the mirror, so pre-emptively disgusted is she by what genital horrors might await. I suspect that this reluctance to look, to really look, at one’s own body says more about social conditioning than anything else. Girls often learn from an early age that their anatomy is shamefully private, out of bounds even to themselves, only to be spoken of in hushed tones and flowery euphemisms, while a boy might play cheerily with his penis in the bath as soon as he locates it. This learned behaviour can beget years of confusion, discomfort and even inconvenience – often an hour-long trip to Triage could be saved by a sneaky peek below – but as I listened to this timid voice from afar, I knew there was no point in insisting that she inspect her scar at home.
‘It’s difficult to tell exactly what’s happening, from what you’ve described to me over the phone,’ I said carefully, taking her details and scribbling on the call sheet: Vague history; patient describes tender wound but sounds generally well. I ripped the sheet out of its book and added it to the pile of others that had accumulated on the desk that day. We’d reached the point in the afternoon when it was hardly worth keeping track of who was coming in and who had already arrived; what would be, would be.
‘Why don’t you pop along to the hospital, Jas,’ I suggested, ‘and we’ll assess you as soon as we can. It’s a wee bit busy at the moment,’ I said, with practised understatement. In the corner of the waiting room, a woman had begun to argue vociferously with her partner over the last drumstick in the bucket of chicken they’d brought along for sustenance. Fair play, I thought, surveying the seven other women tutting and sighing behind the glass partition. You could be waiting a while.
When Jas arrived in Triage, she looked every inch the newly minted yummy mummy. She was slim, petite and neat as a pin; her glossy black hair was tied up in a perfectly spherical bun, and she’d matched her red lipstick exactly to the baby-changing bag slung over her shoulder. When I offered to carry the car seat she’d brought, her cherub sleeping peacefully in its cushioned confines, she simply smiled and lifted the seat as if it was nothing.
‘I can do it myself,’ she said. ‘But thank you.’ I had been expecting a wilting waif who could barely hold her own weight, but a calm, capable mother had come in her place. I returned Jas’s smile – mirroring, always mirroring – and guided her to bed one.
‘Jas,’ I said, ‘your observations are all normal and reassuring. Is it OK if I have a little look at your wound now? If I have any concerns, I’ll ask the doctor to come and see you too.’
Jas smiled brightly. ‘Of course,’ she said, unzipping her jeans and wriggling them down until the waistband sat below the twin arcs of her hipbones. Her abdomen was a smooth expanse of taut, tawny skin; she was one of the few women whose luck (or, more likely, genetics) had allowed them to avoid the burst-balloon look of most new mothers. With almost no overhang to speak of, Jas’s wound was easy to see: a neat red line running across her belly. I made a mental note to find out which doctor had performed the Caesarean; the even incision was the confident work of a master. Slipping on a pair of blue gloves from the bedside trolley, my fingers slid smoothly along the contours of the wound. There was no gaping, no oozing, no flap of skin ‘sitting proud’ of the opposing edge. Jas’s scar could have graced the pages of a textbook.