by Leah Hazard
At the best of times, when the baby’s size and position are a perfect fit with the dimensions of the mother’s pelvis, and when the mother has energy and enthusiasm to spare, the pushing achieves its goal. The baby is inched further and further from inner space to outer, every hard-earned advance followed by a tiny retreat in an age-old dance of ‘two steps forward, one step back’, before finally, a mighty push sends the head bursting forth. There is a pause; time itself seems to hover watchfully while the mother’s body gathers itself again. Then something shifts in the room – a change in the air pressure, a spatial unfolding invisible to the eye – and there is a final push. At last, the baby is cast wholly and completely out of its host, into the waiting hands of – more than likely – the midwife.
Sometimes, though, the fit is not so good, and the journey becomes long and arduous for both mother and baby. The baby is too large, or its position unfavourable; the mother’s pelvis is too small, or her energy has ebbed after a labour that has already seen the sun rise and set several times. In these instances, the body’s own reflexive pushes are not enough. The waves roll on and on, but they become shorter and weaker as each feeble surge yields a diminishing return. The midwife begins to tell the mother when to push, and how hard, and for how long – ‘Put your chin on your chest! Now hold your breath and push into your bottom – wee bit harder, wee bit longer, wee bit harder, wee bit longer – and again –’ but this incantation is often a futile prayer, and only serves to deepen the despair of the woman who has already given all she has, and more.
What happens when a woman pushes and pushes, and then is told to push and push again, until her eyes become bloodshot, and her sweat runs dry, and even her bones cry out with exhaustion? And what if this woman is wearing a cornflower-blue tunic, and an ID badge, and a fob watch? Can she still keep pushing when it becomes normal to miss her breaks, to run out of beds in which to put desperate, weeping patients, to do the work of absent colleagues who have already fallen away, clutching sick notes for stress and exhaustion? Can she push when she has missed her children’s birthdays, and Parents’ Night, and Christmas, when she is told again and again that she must cancel her plans and change her shifts ‘to meet the needs of the service’? When her sleep is haunted by the faces of the women whose pain she could not ease, and the babies she couldn’t save, and she wakes in the morning with her heart already in her throat, what then?
Leaving My Post
I wish I could say that there was one thing that did it – a disaster with a patient, or a soul-breaking bust-up with a ward sister. It would be so much easier to point to something – something outside myself, some unmistakeably painful event – and say, Look, there it was, this is why. You would understand. You would nod in sympathy as you read the words on the page, and you would think, Yes, of course that’s what she did. I would have done the same.
When I arrived for my shift in Triage that evening, six of the beds in the treatment room were occupied, and there were another eight women and their angry, restless entourages in the waiting area. But the truth was, I had had busier shifts. Yes, I had also been off work earlier in the week with yet another vomiting bug whose onset had been sudden, vicious and luridly hued. Although the sickness had stopped, my stomach was still churning, and this, along with the summer sun blasting through my bedroom window, had prevented me from having my usual pre-night-shift nap. I had downed a treacle-thick coffee before leaving the house, standing jelly-limbed by the sink and tossing the mug back like a shot of tequila. The caffeine rushed through my bloodstream as I surveyed the chaos of Triage; my teeth ached and my eyes jangled with the jolt. But the truth was, I had felt worse.
Stella, the other night-shift midwife, was already at the midwives’ station. I was glad to be on with her; she was unfailingly calm and kind, an anchor in the storm that surrounded us. Our eyes met over the desk, and before I could even say anything, she announced, ‘We can only do what we can do. Take your time. They’ll all get seen.’ I tried to smile, but with the caffeine stiffening my jaw, it must have looked more like a grimace.
Betty and Madge had been on the day shift, and as the phones continued to ring mercilessly at the desk, they were already gathering their things – Betty’s sequinned tote bag, Madge’s cigarettes that she’d stashed in a drawer – and they gave a hurried handover as they prepared to make their exit.
‘I’ve got beds one, five, six, and the side rooms,’ Madge said. ‘Bed one is a prim bleeder at eighteen weeks with fresh post-coital spotting. Beds five and six are labourers – five is a para two at term plus seven who’s six centimetres with intact membranes, and six is a para one at thirty-six and six who’s four centimetres, but labour ward can’t take either of them yet because they’ve got no rooms and no midwives, so good luck with that. The first side room is a nine-week vomiter with complex social work and a needle phobia, so she’s refusing IV fluids even though she’s spewing rings round herself. And the other side room’s a thirty-three-weeker who phoned up with severe abdo pain and diarrhoea, but she’s just tanned a fish supper and fallen asleep.’ She stopped and drew breath. ‘Sorry, girls. We did what we could.’ She was gone before we could ask for a recap.
Betty was poised with her car keys in her hand before she even began her part of the report; I could feel her desperation to leave the place behind. ‘So I’ve got beds two, three and four,’ she began. ‘Bed two is an SROM from this morning who’s not contracting, but she’s draining grade-two meconium and starting to feel a bit unwell. The CTG’s had a few early decels on it but she’s another one who can’t get into labour ward until they knit themselves some extra midwives.’ I glanced at Stella; her face was still carefully arranged into a semblance of calm, but I could see the worry twitching in the corners of her eyes as Betty continued her report. ‘Bed three is a query cholestasis; her bloods have been sent but we’re waiting for a doctor to review her results – they’ve all been in theatre for hours so there’s no point paging them. And bed four is a prim in early labour whose boyfriend’s an arse. End of story.’
‘Thanks,’ Stella and I said in unison, although the word was more of a formality than a genuine expression of gratitude.
‘I’m on again tomorrow, so I’ll see you in the morning,’ Betty called over her shoulder as she disappeared through the double doors.
‘Hurry back,’ Stella replied, and I thought I could hear a sharp ‘Ha!’ from Betty as she left the unit. The incessant clatter of the phones made it hard either to hear or to think. Stella and I looked at each other.
‘I’ll take Madge’s,’ she said.
‘I’ll take Betty’s,’ I agreed.
And without another word, we began to work.
The next few hours flew by in a kind of psychedelic blur; screaming faces and splashes of blood passed in front of my eyes in endless rotation. I worked like a bastard, as the oft-used local expression would have it, but the harder I hustled, the less I seemed to accomplish. Doctors were nowhere to be seen, a shortage of staff and beds had made the labour ward impenetrable to all but the very sickest patients, women kept streaming through the doors of Triage, and the phones kept sounding their nerve-jangling alarm. Bed five delivered; Stella caught the baby while I rummaged blindly through the emergency trolley for drugs, clamps, scissors and towels. Bed six’s mother was appalled by the noise. Bed four’s boyfriend complained about the puddle of fluids that was seeping across the floor into his girlfriend’s bed space. Bed one continued to bleed, bed two’s CTG recovered from a sharp deceleration that had drummed for one heart-stopping moment above the general din, and bed three was now engaged in a very loud and animated telephone call in a language neither Stella nor I recognised. For all we knew, the side rooms were swimming in excretions of one flavour or anther – their occupants hadn’t buzzed, and we’d get there eventually.
And still the phones rang at the desk. After bed five had birthed her placenta, and she and her baby had been tucked up in clean sheets, it occurred to me that
maybe I should take some calls in between checking on my set of patients. Morven, the auxiliary, had been doing her best to juggle the phones so far. ‘I’ve got five callbacks for you,’ she said when I approached the desk. ‘And ambulance control are on their way in with an unbooked labourer.’
I glanced down at the fob watch on my chest; apart from calling out bed five’s delivery at 22.36, my concept of time had dissipated into a fog. The night had become a kind of ridiculous, Alice-in-Wonderland race in which Stella and I ran furiously on the spot, going nowhere, with no rules and no reward. The hands on my watch were creeping towards midnight. I couldn’t get my head around it – what had I achieved? The waiting area was busier than when I had arrived; women paced around the chairs while their men glared at me, unblinking, their mute fury radiating across the room. I picked up one of the phones.
‘Triage, Midwife Hazard speaking, how can I help you?’ It occurred to me with grim irony that this standard greeting could hardly have been more apt under the circumstances. How can I help you? Can I even help you at all? I stifled a laugh.
‘It’s Rhona. I’m phoning for the numbers.’ It was the labour-ward sister, doing her usual night-shift check on all of the departments and their bed states.
‘Rhona, we’ve got eight patients in beds and – I don’t know how many more queuing up.’ I looked over at the waiting room. A woman with shocking-pink hair was pointing at me and shouting something at her partner, a muscle-bound man in a lime-green T-shirt who was rocking one of the vending machines back and forth on its stubby legs, trying unsuccessfully to dislodge one of the sugar-bombs within. When he roared in frustration, the woman roared louder, her mouth a bitter, crimson snarl. The colours were too bright, and their faces too twisted; nausea roiled the dinner that sat lumpen and undigested in my stomach.
‘I don’t think we’ll be able to get any breaks, at this rate,’ I said into the phone. ‘Any chance someone could come and relieve us?’
‘Not the way things are looking,’ Rhona said. ‘The whole place is short, so there’s nowhere I can pull from. Sorry.’
‘Any chance my labourers can come up? One of them’s actually delivered.’
‘All of our rooms are still full, and my last midwife’s gone to theatre with a major haemorrhage. Sorry.’
The nausea became a slow tide of acid, climbing up my throat. Now my heart was racing, and I had a vague awareness of pins and needles in my hands. I sat down at the desk, handset cradled between my chin and shoulder. Morven had answered the other phone and was pointing at it, then at me. I shook my head.
‘Rhona,’ I started. What could I say? We were both powerless against the rising tide. ‘Surely we need to shut the hospital.’
She sighed down the line. Closing the hospital to further admissions and diverting women to the next closest maternity unit was a last-ditch measure when things became really, truly hellish – when every single bed in the hospital was occupied, regardless of whether there were midwives to care for them. It did happen once in a very great while, but hospital bosses were incredibly loath to pull the trigger, as putting the unit on ‘divert’ incurred heavy fines and, occasionally, bad press. Nobody wanted to be responsible for the ensuing mess.
‘You know as well as I do,’ Rhona said, ‘that it’s out of my hands. The hospital can only close when every bed in the place is full. Which isn’t the case yet.’
‘But it’s not safe,’ I protested. My voice was small, and sounded even to me as if it were being broadcast from a great distance, like an astronaut radioing to ground control during a particularly tricky spacewalk.
‘I’m sorry,’ Rhona said. ‘I know you’re doing your best. We all are, but I don’t make the rules. I wish I did. I’ll call you back as soon as anything changes, and if I can send help, I will.’ And she hung up.
I sat back in the chair. People kept apologising to me – Betty and Madge, then Rhona – but for what, and to what effect? The situation was beyond anyone’s control. The staffing, the bed state – it had all been written in the stars, or at least sketched out long ago in an office far away by some middle manager tasked with minding the government’s meagre purse, while across the area, people continued to breed. Waters broke onto bathroom floors in gushes and trickles; babies squirmed in the womb; husbands dashed through red lights while their wives groaned and pushed, jammed between back seats and footwells. Life pulsed through the city: unstoppable, terrifying, constant. My head swam with it, and for a moment, my vision began to tunnel. I blinked twice and the darkness in the corners of my eyes receded, but my pulse quickened in response.
By this point in my career, this feeling had become familiar to me: the racing heartbeat, the clammy, tingling palms, the creeping sense of dread. Was it a panic attack? Almost definitely. Was it a natural response to a job whose main prerequisite was hypervigilance – being constantly ‘on’, always alert for any small sign of impending crisis? Most certainly. Since that morning – now many months ago – when Trisha had fled our changing room in tears, virtually every midwife I knew had shared with me her experience of emotional turmoil. Some tales were told in jest over coffees at the desk, some in tears in the tea room. So many members of staff were on antidepressants and beta blockers that anyone who claimed to have a clean bill of mental health was more the exception than the norm. Stella herself – calm, steady Stella – had only recently mentioned in passing that she’d been on pills for years, and could barely function without them. She appeared beside me then at the desk, her white plastic apron streaked with blood.
‘This is crazy,’ she said. ‘We need to move some of these patients through or we’ll have them queuing out the door.’
I opened my mouth to say something helpful, or darkly humorous, or even just blandly reassuring, but the words dried on my tongue.
‘Stella,’ I began. My teeth felt clumsy in my mouth. I looked around, at the piles of call sheets and the clock on the wall, at the empty cans of energy drinks abandoned on the desk by long-departed staff, but none of it made sense. It was like a puzzle with half the pieces missing.
‘Stella, I don’t feel well.’
She looked down at me, her head cocked to the side. The jagged edge in my voice hadn’t gone unnoticed. ‘Your tummy still feeling dodgy?’
‘No. I don’t know,’ I said, stammering. The department was at a breaking point; I was at a breaking point. I couldn’t leave, but I couldn’t work. ‘Yes,’ I began again. ‘I think I’m going to be sick.’
Stella surveyed me coolly. She knew. And I knew that she knew. ‘Go and have a seat in the tea room for a while. Take ten minutes off the floor.’
‘I’m so sorry, Stella.’ Another apology. ‘I don’t want to leave you with the place like this.’
‘You’re not leaving me. Morven’s here. We’ll be fine for ten minutes. Go.’
I didn’t argue. I unfolded my limbs with a conscious effort, stood unsteadily, and marched myself into the tea room, where the door closed behind me. I was – in the midst of everything – alone. The television in the corner was showing an old episode of some game show involving two teams of families answering mildly obscene questions about each other. The host gurned a perma-tan smile; the families laughed uproariously in return. I sat down. I tried to watch the television but couldn’t follow the game. I stood up, got my dinner from the fridge, and shovelled it into my mouth in under a minute: no taste, only texture. I picked up a magazine; the words swam; I put it down. I thought about going back to the desk. I had felt like this before, and had found ways of pushing it away, dampening it down, packing it up until I was home and safe and could fall quietly to pieces in the last few minutes before sleep finally silenced my thoughts. This was different, though. As I sat pinned to the tea-room chair, I felt as though my body belonged to somebody else, as if I were hovering in the corner by the telly and watching myself unhinge. My body had had a natural, normal response to the night’s madness. It had been telling me to remove myself immediately, and I
had refused to listen, so my brain was now taking over. If you don’t leave, it was saying, I will remove you from yourself.
I tried telling myself to get a grip, to return to my post, to suck it up. I stood up, I sat down. I stood up again. I knew what I needed to do, and it killed me.
I found Stella at the desk, where she was scribbling furiously in a patient’s notes, her face set with concentration.
‘Stella. I need to go home.’
She looked up. I braced myself.
‘Yes,’ she said, looking at me. ‘You need to go home.’
‘I’m so sorry.’ Once more, an apology. The place was awash with them. The worse things got, the sorrier we all were.
‘I’ll tell the coordinator,’ she said. ‘I’ll say you came back to work too soon after your bug.’
I could have crumpled with gratitude at this small kindness. ‘Thank you.’
‘We’ll be fine.’
‘I’m so sorry.’
‘I know.’
‘I feel awful.’
‘I know. But we’re all just numbers here. Don’t let it make you sick. Go.’
The phone rang again and Stella answered it. Just like that, she was involved in the story of some other woman, taking her details, listening to her pain. I hesitated. For one last moment, I had the chance to change my mind, to stay in the loop. The other phone line rang. I could have answered it. I turned and left the department.
I blinked in the darkness of the car park; shame and humiliation followed me with every step into the night. I had never been outside the building at that hour. Oblivious to the late-night drunks loitering by Accident and Emergency, I plodded towards my car. The hospital hulked at my back, humming impassively; I could still turn around, but I knew that I would not.