Connect
MJA
MJA

Enough?

Rebecca C Rowe
Med J Aust 2013; 199 (2): 131-132. || doi: 10.5694/mja13.10413
Published online: 3 June 2013
Winner, Practising and retired doctors category

Casey stared, expressionless, at the floor. The floor returned the favour. It was salmon pink linoleum, with flecks of grey. Her eyes lifted to where it met the cheery mint green walls. She wondered what sadist had decided to deck the place out in the upbeat garb of a 1960s ice-cream parlour. Her body suddenly lurched, without warning, and she vomited. Generously. Last night's mushroom risotto cut a swathe across the salmon. That'll show them what I think of their interior design efforts. She afforded herself a thin-lipped smile. “Woman crusades for muted tones in labour ward décor” . . . she could see the headlines now. She'd be a national bloody hero.

Unfortunately, there was no audience for her sarcasm here, for the spontaneous quips and sly witticisms that were such a hit with her social circle. She was completely alone. And she was uncomfortable. Not just from pain, although there was that, inexorably stronger and more frequent, grinding her forward to what seemed like the end. More upsetting was that she'd stuffed up, as usual, and generations of handed-down Irish-Australian pride had prevented her apologising. And so she was alone, here where she most needed not to be. He wasn't coming. Not ever. The fear of the years stretched out ahead of her was real and uncomfortable. Pethidine wasn't helping that pain.

***

“Sorry I'm late”, said the woman as she shuffled into her place and sat heavily, her bulk exceeding the ungenerous proportions of the standard-issue chair. “Claire's not having a good week.” Muffled sounds of pity followed. The woman, Bev, looked up fiercely, as though challenging the others to convert those sounds into actual sentences. No one took the bait. Bev had it tough, no argument there — disabled adult daughter, alcoholic husband — but she coped by making it tough for those around her. A pretty hopeless strategy, really. No one could get close enough to help. They all remembered the scene when the head of midwifery had suggested a period of leave from work. Work was all she had, couldn't the moron see that? They all remembered, and they buttoned it. “Well, we were just doing handover. How about you take room 3?” said an evening shift girl, keen to get on with it. Bev grunted assent. “She's a 32-year-old primip, professional girl, 38 plus; membranes ruptured at home at 20:45, good contractions happening. Three-to-four in ten. She was five centimetres at 21:30. She seems to have a lot on her mind . . . bit distant. No support person, and she doesn't want to talk about it, okay?” A life summarised in point form. “Room 4's empty, I just took her up to the ward.” Short pause for politeness, then a hurried “That's me done, so I might head off”. They all said their goodbyes, and in a rustle of purple cloth she was out into the muggy summer night.

***

All except Naomi, sitting silent and ignored in a corner. A new registrar on secondment, she felt invisible and unwanted here. She wondered what her predecessors had done to deserve this. Or were they punishing her particularly? Because she deserved it? She sipped her brown drink. Coffee? Possibly. She had made it automatically on arrival. Powder. Water. Milk. Sip. Grimace. Night shift resulted in a lot of automatic behaviour.

The handover sounded straightforward — only three labouring women. Which unfortunately meant more time for her to stew. She tuned out as the talk turned social, and fingered the corners of a bundle of official papers in front of her, emblazoned with health department insignia. The “adverse outcome” was going to result in litigation, as well as a root-cause analysis. Naomi couldn't escape the feeling that she herself was the root cause; her poor judgement, her lack of experience had combined and a little life was worse off. People had been encouraging. It happens to the best of us. Night shift. Panic. A difficult instrumental attempted too late. But it hadn't happened to her before.

The coarse scraping of chairs invaded her private lynching. The midwives were done. She smiled shyly at the first face she focused on, wordlessly asking the standard question of the new: “What now?” Bev bored through her with impatient eyes. “We call you if we need you, which is rare. Most registrars hang out in the office, use the computer, or try for some shut-eye.” Subtext: “Go away”. Naomi was happy to comply. She had plenty to keep her busy, right inside her head.

***

Casey now felt as though nothing outside that room could possibly exist anymore. Had she been there hours? Days? She couldn't tell. It felt like all she knew. “I'd like to go home now . . . please . . . just pass my bag and I'll go. I really can't do this any more.” She heard the polite, ridiculous request and took a moment to recognise her own voice. It sounded small. Another contraction hit and she lost even that small voice. She buried her face in the uniformed shoulder of the older woman, and breathed in the familiar smell of talc and nicotine. Like her own mother, Bev was a smoker. “You're doing well, use your breathing”, said Bev, firmly but kindly, not minding the combination of snot and tears on her sleeve. “I can't . . . shit-it-hurts-make-it-sto-o-op.” “Now you're going to be a mother and mothers don't swear” was the retort. “Up on the bed; let's see where we're up to.” The pain now over and the fog of gas thinning, Casey moved to the bed and muttered, “Well you're supposed to be a health professional, and health professionals don't smoke”. Unexpectedly, Bev laughed, roughly and loudly like a motor out of regular use. She was enjoying the banter. Bev was always pleased when the girls were plucky. She loved women. She believed they could cope with anything God threw at them, and she knew from personal experience what a strong arm He had. But to cope with humour rather than mere stoicism was impressive. This one would do alright, man or no man. “I'm the last of the old guard”, Bev replied. “Besides, one look at me should tell anyone smokes are bad news. If you think about it, I'm performing an important public service, just by existing!” The examination revealed full dilatation. “Now let's get pushing!”

***

Naomi was vacantly scrolling through an online newspaper article when the buzzers sounded. Three sharp bursts — code for “help” in any labour ward anywhere. She hurried out into the corridor and followed the other staff and wounded noises to room 3.

“Give me another push, girls give me a hand with these legs . . . up to her chest, that's it”, Bev called.

“What's happening to me?”

“Baby's shoulders are stuck, Casey, we need to get her free”, then in an undertone to a colleague, “Call the paediatrician. Now!”

Shoulder dystocia. One of those heart-in-mouth situations, like a sudden bradycardia, or heavy postpartum haemorrhage. Seconds mattered. Naomi rushed on gloves and took her position. The baby's face was deep purple. The last contraction and repositioning of the patient had achieved nothing.

“I'm going to try to free baby's back arm, use your gas”, Naomi said, too loudly. She always felt the need to shout in emergencies, but over what? The feeling of fear and chaos in the room, perhaps. It screeched and knocked about her like so many bats. She fought the urge to put more pressure on the head, and instead forced fingers inside Casey. She couldn't get to the posterior arm . . . wait, was that it? Casey screamed, begging her to stop, to take her hand away. Then she thought she had it, a finger in the axilla. She swept it forwards firmly, and the arm slipped across the body and out, hanging floppy and blue, creating vital space. She quickly delivered the baby, clamping and cutting the twisted rope of cord, and reached the resuscitation area in two ungainly steps. She rubbed the slippery, inert human with the towel, and its mouth opened wide in a mime of indignation. She rubbed again, ready to start ventilating if needed, but this time the little person took a breath and added sound to that complaint. A pink hue spread across chest and face.

She returned the baby to her mother's chest and sat by the bed, ready to run through her explanation of what had happened and why. But when she looked up, Casey was fully absorbed, inspecting her baby in wonder. The other midwives had drifted away, and it was just Naomi, Bev and Casey, sitting on and around the bed, looking at the angry new little girl. “She doesn't seem too impressed with the world!” said Casey proudly. “Smart cookie”, Bev replied. She offered a nod of appreciation to Naomi. The rising panic of thirty seconds earlier had been replaced by a softness, a quietness they couldn't name. Relief? Fellow-feeling? Yes, those too, but there was also joy. It would be enough for today.

  • Rebecca C Rowe

  • King Street General Practice, Newcastle, NSW.

Correspondence: rowe.rck@gmail.com

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.