by Leah Hazard
I drove home in silence through streets that were empty apart from an occasional ambulance, blue lights flashing towards some distant emergency. In my head, I saw the desk at Triage, saw Stella phoning Rhona to explain my departure, heard Rhona’s incredulous reply. And of course, there would be gossip among the other midwives who had seen me earlier on.
‘She was fine at the start of the night,’ I imagined one of them saying.
‘She’s at it,’ said another.
‘She couldn’t cope,’ chimed a friend.
‘You know what her problem is?’ added another voice, and then, finally, the ultimate insult: ‘She’s too nice.’ Ironically, this was the worst thing any midwife in my unit could say about a colleague. We all knew that in our ‘caring profession’, the ultimate sin was to be too soft, too kind, with a thin skin too easily needled by the challenges of our trade, and a heart too warm for its own good. The ones who lasted could be hard when it mattered, could be cold when it counted. I was learning – working on growing a little shell around myself, a cornflower-blue exoskeleton – but much as I had tried, I knew I could never be hard or cold.
Somehow, suddenly, I was home. I sat in my car outside my house as the engine ticked and cooled, and I wondered if my children would hear me coming in, and would lie rigid in their beds with fear, imagining a midnight intruder. It would never occur to them that their mother might come home in the middle of a night shift. They were used to seeing me stumble in, bleary-eyed, in the morning, saying hello and goodbye as they trundled off to school, so bright and fresh by contrast in their own clean, pressed uniforms. Now I would need to creep past their rooms, but then the comfort and safety of my own bed would be sweet relief. I could curl into my husband, could explain it all to him, and he would tell me it was fine, and I would try to believe him, and I would sleep.
As it happened, nobody heard me open the door and tiptoe up the stairs. I slipped out of my uniform on the landing and fumbled blindly for my bedroom door, and then for the edge of my bed. The sheets were cool against my skin. My husband sighed and rolled over, still asleep. I nudged him awake, and in the darkness I could see him blinking at me, uncomprehending.
‘I had to come home,’ I said.
‘Hmmph,’ he sighed again, more out of simple acknowledgement than any kind of judgement or reassurance, and closed his eyes.
‘I was sick,’ I said. I waited for his reply. Minutes passed, until his breathing became heavy. I was sick, I told myself. I was sick. And eventually, minutes or hours later, my own breathing steadied, and I closed my eyes, and I slept.
Going Home, and Finding the Way Back
Another hospital, in another country.
I was on the eighth floor, sitting next to a window that offered a view of the town where I grew up, its colours bleached to dust in the July heat. There were clusters of office buildings, neo-Gothic university spires and row upon row of houses, clapboard and colonial, sprawling in every direction towards the tree-lined hills. Yet from this height, within the double-glazed, air-conditioned bubble of the ward, the street-level noises were silenced and the town looked empty and still. I tilted my face into the afternoon sun and closed my eyes, like a cat. It was a rare pleasure to sit at peace in a busy hospital; my breathing barely quickened at the sound of a distant buzzer.
I sank back into my chair and enjoyed the sensation of its vinyl sticking to the backs of my thighs. This feeling reminded me of childhood road trips; long, sleepy journeys punctuated by arguments with my brother and slugs of flat strawberry soda. Reaching our destination, we had to peel our legs off the broad bench seats, our flesh bearing the perforated imprint of the leatherette upholstery for hours. I opened my eyes and was momentarily surprised and disorientated by the sight of my father sitting across from me, and then I remembered: we were both older. I was in America, and my father was sick.
Between us was a wheeled table on which my father had arranged five miniature cans of diet ginger ale. He may have been old, but he still took a boyish delight in the kinds of treats that were rare – or even forbidden – in the post-war Montreal of his childhood. The chemotherapy ward had a visitors’ kitchen with an endless supply of fizzy drinks, yoghurt and Saltine crackers. My father had passed the first part of the day filling himself with every free food and beverage on offer in between casting half-hearted glances at the sports pages of the newspaper. Under the table, a towel was draped carefully over his lap. His bladder cancer, although only detected weeks before, had already had some embarrassing side effects, and the nurses had discreetly bagged the shorts he had been wearing when he arrived.
Ward staff padded back and forth across the floor, their clogs thwacking gently as they passed: another familiar sound. The curtain around our little world by the window was drawn back, and two nurses appeared with my father’s next intravenous bag. They aimed the ghostly green beam of a handheld scanner at the bag’s label, then at each other’s badges, then at the barcode on my father’s wristband. The women nodded briskly as each item in turn elicited a flash and a beep. To me, this seemed very high-tech, and in contrast made my own clinical practice seem almost quaintly old-fashioned. Whenever I checked a controlled drug or a complicated infusion with a colleague, we countersigned our names with pen and paper, and read out the handwritten numbers on our patient’s ID band to confirm her identity. In fact, everything about this hospital was familiar, but fancier. As a senior academic at the university, my father was lucky to have the best private healthcare, and everything from the waterfall in the foyer, to the sushi in the canteen, to the freebies in the kitchen, spoke of money.
Regardless of the sheen of luxury, I recognised and appreciated the care my father was receiving. His diagnosis had come as a shock, and the planning and execution of his treatment had been carried out with dizzying speed. I was jet-lagged from my last-minute trip across the Atlantic and my father was tired from his own exertions, but the nurses who lingered by his chair to adjust his drip or refresh his drinks were unfailingly kind. For me, who was so used to being the carer, it was marvellous to be cared for. I felt grateful, almost embarrassingly so, for every kind word and can of ginger ale. I shifted in my armchair, mentally noting the name of every nurse for the thank-you cards I planned to write when I got home. These men and woman were going to try to fix my father, and from where I was sitting, their existence seemed nothing short of a miracle.
As I allowed myself to become absorbed in this world of comfort and kindness, a small voice spoke from the back of my mind. It began to suggest to me that perhaps I also did what these nurses were doing, albeit in a different branch of the health service, in a different country. I was struck all of a sudden by the blindingly obvious but no less mind-boggling possibility that some of my patients might feel about me the way I felt about my father’s carers. Years ago, I had voluntarily placed myself slap-bang in the middle of midwifery’s slipstream, the wash of bodily fluids and pain becoming so routine that disgust was soon an alien emotion. Having come so far from my first clueless shifts as a student in oversized scrubs, now it wouldn’t have even occurred to me to recoil, or to wrinkle my nose. I cared for women. Clean ones, smelly ones, beautiful ones, rude ones, rich and poor ones, lost and lonely ones.
The small voice dared to become incrementally louder. You love them, the voice said. You love the secrets they share and the endlessly different histories they bring to your door. You love their humour – the jokes they crack at the bleakest times, and the laughter they draw from your hoarse, aching throat as effortlessly as water from a well. You love them even when they curse and complain; you understand that pain has set their bones alight. And here’s the thing: some of them love you back. I gazed out of the window: the view was the same, still parched pale by the sun, but something in me had changed. In spite of the fact that my job had recently eked every last drop of energy and spirit from my body, I realised – almost as if the thought were occurring to someone else, in a happier echo of the out-of-body terror that
had driven me, shaking, from Triage – that I was actually looking forward to getting back to work.
As I drew myself up in my chair, feeling suddenly taller, bolder, my father also shifted in his seat, setting the neatly folded newspaper down on his table. He moved carefully, trying not to upset the drip that was pulsing a steady dose of poison into his arm. ‘So talk to me,’ he said, looking wearily at his cannulated hand. ‘This is going to take a while.’
Although my father had visited me frequently over the years in my ‘new’ home across the ocean, those visits had often been punctuated by distractions – happy ones, like my own children, or more irksome ones, like jet lag and illness – and I couldn’t actually remember the last time we had been able to have a relaxed, unhurried conversation. It was a privilege and a delight. This was the man who used to wake up early on summer holidays to bring me blueberry muffins and apple turnovers, because they were my favourite; the man who used to tell me endless bedtime stories about a young girl who was equal parts spy, ninja, rock star and genius, and whose adventures always involved wild derring-do culminating in international fame. This man needed me now, and he wanted me to tell him some stories. Work was on my mind, and so was love – love for the women in my care, and love for my dad – so I dug deep and came up with the best tales I could tell.
Over the course of the next few hours, as the sun began to cast long shadows over our little curtained bay by the window, I told my father about some of the women who had recently passed through the Triage doors: the prims whose faces wore the naked shock of labour pain, the woman who walked calmly up to the desk with the bulge of a baby’s head just visible in her trousers. I told my father about the easy, joyous births, and the long, torturous labours that left me aching for days, with a creaking back and bruises above my hips. (‘Put your feet here,’ I often said. ‘It will give you something to push against.’) I told him about Eleanor and her unlikely journey to motherhood, and about perfect, pretty Jas, whose wound I had washed with tenderness. And I spoke at length about Pei Hsuan, and about the square of paper on which she had mapped out the pain and degradation of her journey to a country where she had been promised better.
My father listened in rapt silence. Nurses came to take down the empty bag of chemotherapy fluid, and to disconnect his drip, gliding away as quietly as they had appeared. The sky outside became a deeper blue as it cooled, and the city seemed to stretch and sigh with relief. Out of the corner of my eye, I saw the slow crawl of traffic, and the sway of trees.
‘These stories are phenomenal,’ my father said. His voice was urgent. ‘You’ve got to write this stuff down.’
‘Really?’ His fascination surprised me. My father had always expressed polite interest in my work, but had never appeared to be so moved by it – or perhaps I hadn’t given him the chance, hadn’t bothered to share beyond a glib joke or pithy anecdote, hadn’t presumed that my little world was worthy of consideration beyond the bookends of my twelve-and-a-quarter-hour shift.
‘Really,’ my father replied. ‘People need to know about these women, and they need to know that this is what midwives do. It’s – it’s just amazing.’
I didn’t tell my father about the toll the job had taken on me; about my racing heart, or my midnight terrors. For the first time in a very long while, I turned firmly away from the fear and the sadness. I felt uplifted by the small, strong voice in my head, and by the time spent with this man whose love for me went far beyond freshly baked muffins and bedtime stories, and by his genuine enthusiasm for what I had to say. I wanted to capture the feeling, to hold on to it, and to carry it back with me to my own hospital, in my own country, where I had chosen to live and serve.
Later that week, after the chemotherapy was finished and my father and I had embraced and whispered muffled goodbyes into each other’s necks, I looked out of an aeroplane window and watched the twinkling lights of my homeland recede into darkness. When the seat-belt sign pinged off, I unlatched my tray table, dug a pen and paper out of my bag, and began to write.
The Cavalry
Those footsteps you hear are mine.
I’m running down the corridor with a bag of O-negative blood tucked under my tunic. There’s a major haemorrhage in Triage and I’m hoping that my body heat will bring the fridge-fresh blood up to a comfortable temperature before it’s dripped into the veins of the waxen-faced woman lying in bed three, thronged by doctors and machines. Oblivious to the staring faces that line my route, I clutch the bag to my belly, willing the woman to hold on until I return.
These are also my footsteps: the dragging plod of one battered trainer in front of another as I leave the hospital after a soul-crushing shift. I long for the sight of my family almost as much as I wish for the numbing embrace of sleep. I pass the sculpture of the pregnant woman, her bump now thickly plastered in pigeon shit, her face as inscrutable as ever, and my feet weave through the scattered debris outside the building, as they have so many times; around a gelatinous pile of sick, past the cigarette stubs and crisp packets that have settled in filthy rings around the bins. I don’t know if I can do it all again the next day, and yet my heart knows that I will.
By the time you read this, I will have made that journey home and back many more times. I will have penned a dozen letters of resignation in my mind, but none will have made it onto paper. The job continues to take the best of me: my vigour, my compassion and even, at times, my health. It also continues to show me the best of what humanity can be: bold, brilliant, fearless and fierce in the face of pain and sorrow. The women in my care have taught me what it means to give love and to receive it, to triumph over unthinkable adversity and, sometimes, to accept defeat and loss with grace. For that reason, I return. I remain – in name, for now, and in my heart, for ever – a midwife.
My dedication is not exceptional, nor are my skills. I’m not the best midwife in the world – not even close. I’ve been in the job long enough to have an opinion, but not long enough to approach the hard-earned wisdom of so many of my senior colleagues. I can’t claim to speak for every midwife everywhere. The fabric of my experience may share common threads with that of other midwives, but there will be midwives whose working environments are very different from mine, and whose feelings about the future of the maternity services are far less conflicted. There must be midwives who always feel peaceful and fulfilled at their work, whose units are well resourced and appropriately staffed, and who are able – shift after shift – to give the gold-standard, woman-centred care to which we all aspire. I just haven’t met them yet. In the current climate of bed shortages and staffing shortfalls, this kind of midwife is a mythical figure – the Pegasus of our profession, her wings sprinkled with a fairy dust the rest of us can only dream of.
For the women I work alongside, and for the women we serve, I’ve realised that our voice – maybe even my voice – is worth raising, and that this is a story worth telling, and telling now. From the earliest days of my practice, I realised that the world of midwifery is so much stranger and more entertaining than fiction – hardly a day goes by when one of my colleagues doesn’t marvel that ‘You couldn’t make this stuff up.’ I imagined that I might write some of these stories down after my retirement (as others in various medical fields have done, to great effect), when hindsight may have softened some of the harder edges of my experience, and the threat of professional backlash might become somewhat moot. However, since the current government has decided that I won’t be able to claim my pension until I’m sixty-seven, I have to wonder whether I’ll be physically and mentally capable of practising midwifery long enough to ‘retire’ in the traditional sense of the word. I’m less likely to be doing night shifts and hauling beds at sixty-seven than I am to leave the profession before my knees, hips and sanity are beyond repair. Every day, my colleagues echo this concern, vowing to reduce their hours or to leave altogether as soon as mortgages are paid, debts are fulfilled, families are raised, and before the increasing desperation and fear-f
uelled blame becomes too much to bear. Midwives are, on the whole, an ageing population, and if we don’t let the world know how under-funded and over-burdened we are, we will never make the health service a place where the next generation of midwives can practise safely, with dignity and pride.
In some ways, I know, I shouldn’t complain; I should check my privilege. I appreciate that I’m incredibly lucky to practise in a hospital with clean bedsheets, sterile instruments and a virtually endless supply of sophisticated medication, all of which are free to the user at the point of service. I know there are many midwives working around the world for whom even the most basic medical supplies are hard to come by, but that doesn’t change my situation, and it won’t silence my call for improvements. Regardless of what’s happening elsewhere, for a maternity service in one of the world’s wealthiest, most developed countries, we can and should do better for our midwives and for our women.
Sadly, the government is unlikely to prioritise this sector of healthcare until and unless there is a total sea-change in our cultural perception of midwifery and the difference midwives can make to public health – and to women like Crystal, Hawa, Olivia and Star, who span the full spectrum of circumstance and need. Even with an increasing number of depictions of midwifery in the media, there still seems to be a lack of awareness of the role’s breadth and complexity, and of the almost superhuman feats of physical and psychological endurance required to carry out those duties.
This realisation dawned on a first-time father whose wife I looked after recently. Steven and Michelle had arrived in Triage with all the nervous enthusiasm of new parents-to-be. Michelle was still smiling bravely through her contractions, and Steven was juggling a set of matching suitcases while also entering crucial data into the contraction-timing app on his phone.