Hard Pushed

by Leah Hazard

  I felt an embarrassing twinge of envy during this examination. My own Caesarean wound, now fifteen years old and little more than a silver seam, had been stapled instead of stitched, for some reason I’ll never know or understand. For the first few weeks after my daughter’s birth, I looked and felt like Frankenstein’s monster – a tired, tearful, patchwork ogre. I’ve seen this slightly unhinged look in the eyes of so many new mothers, and for those whose labour is punctuated in the eleventh hour (or twentieth, or thirty-fourth) by an emergency Caesarean section, that sleep-deprived delirium is often exacerbated by the sting of guilt and disappointment. The hours of antenatal classes; the meticulously memorised visualisations and affirmations; the colour-coded, four-page birth plan – all end up on the cutting-room floor of the operating theatre. This mode of delivery can be life-saving, and many women are happy to embrace it as such. However, for others, the grim show-reel of this often traumatic experience plays on a loop until time renders the images grainy enough to ignore. I searched Jas’s face for some sign of this inner turmoil, but her expression gave nothing away.

  ‘Jas,’ I began. ‘It’s totally understandable that you’re exhausted all the time; your body’s been through so much. You’ve had quite a substantial operation, which may not have been how you imagined things would go.’

  She blinked at this, but resumed her steady gaze. I decided to continue; perhaps some part of my rambling monologue would hit its mark.

  ‘You’re probably surviving on a tiny amount of sleep, and it takes a huge amount of energy to meet your baby’s needs. But as far as your wound goes, I can’t see any obvious problems – in fact, the doctor seems to have done a beautiful job.’

  She looked away then, and I thought I saw the wet gleam of a tear in one of her eyes.

  ‘Have you been particularly active, maybe, in the last few days? A section cuts through many layers of tissue, not only the skin, so everything underneath will still be trying to heal. If you try to do too much too soon, it can feel quite painful.’

  That did it. A single perfect tear slid down Jas’s cheek. Her lower lip began to tremble, and then another tear followed the first, and then another, until two slick tracks made pale lines through her make-up.

  ‘There are just too many hours in the day,’ she whispered, her eyes still downcast.

  I wasn’t sure I’d heard her correctly. Too many hours in the day? I was unpleasantly familiar with the concept of there being too few hours – the combined demands of midwifery and parenting and general life admin had been particularly onerous of late – but too many hours?

  ‘Sorry?’ I said softly. ‘What do you mean?’

  Jas looked up then; her eyes were already bloodshot, and her lipstick was smudged where she had tried to wipe away a tear with the back of her hand. The mask had slipped and she was ready to talk.

  ‘My husband was only off work for four days after Beena was born. He’s self-employed, so if he doesn’t work, he doesn’t earn. It’s OK – I don’t blame him – but it’s just … now that it’s only me and Beena in the house for almost the whole day, time seems to drag and drag. I mean, I have to feed her, but when that’s not happening, I don’t know what to do with myself. I’m an accountant; I’m used to having people around me all day, being busy, going to meetings. But now there’s … all this time, and if I don’t do something, I end up thinking about the birth again and again. How it went. How it should have gone. The look on my husband’s face when they took me to theatre.’

  I winced at this. It wasn’t until years after my own Caesarean section that my husband told me what had happened after I was wheeled out of the delivery room to be prepared for surgery.

  ‘They sent me to what was basically a broom closet to get changed,’ he said one night as we lay in bed in the dark, exchanging sleepy confidences. ‘I thought you and the baby were both going to die, and I had visions of myself leaving the hospital alone.’ It turns out I wasn’t the only one of us with a vivid inner show-reel, but my husband had kept his memories to himself until mine had begun to fade.

  ‘I have to stop myself thinking about his face,’ Jas said, echoing my thoughts. ‘I have to pass the time – all those hours – so I clean.’

  ‘You clean?’ I asked. ‘How much?’

  Jas sniffed, took a deep, shuddering sigh, and looked me squarely in the face.

  ‘I clean the house three or four times a day. Top to bottom. The carpets, the surfaces, the kitchen, the bathrooms. I make the beds. I sterilise Beena’s bottles twice for good measure, and then I do the dishes, and then I start again.’

  ‘So you’ve been … pretty active.’

  ‘Yes.’

  I took a smaller but no less weary sigh. Suddenly I was aware of the noises behind the thin curtain that divided bed one from the rest of the room: I could hear the beats of the CTGs at the other bedsides, a man laughing and a woman snapping at him in rebuke. The phone, as ever, was ringing. I watched Jas push the damp hair back from her face, tucking a few wisps back into her shiny bun, and I wondered if I had the time, energy and insight to give her what she needed. Her emotional state was complex – a knot of anxiety, disappointment and mildly obsessive behaviours, with a slender strand of post-traumatic stress woven through the tangle, impossible to unpick in an afternoon. Hers was the conflicted, contradictory and simply scunnered brain of the average new mother.

  ‘Jas, what you’re feeling – all of it – is completely normal. Having a baby is a huge change. It’s like a bomb going off in the middle of the life you had before. Everything’s different, and when you’re on your own all day, it’s easy to feel isolated and overwhelmed.’

  She looked at me and nodded. She was obviously hearing what I was saying, but it was impossible to tell whether she was really listening. Her eyes, tearful and searching only moments before, had now begun to glaze, and I recognised that look as the very same one my teenage daughter gave me when I attempted to impart any pearls of maternal wisdom. The shutters were coming down.

  ‘Cleaning is normal too,’ I continued, hoping to reel Jas back in, ‘but cleaning three or four times a day is … maybe a bit much. Life’s too short, and Beena will only ever be a baby once. Slow down. Be kind to yourself. And ask for help if you need it.’

  I recognised the futility of these platitudes as soon as they left my mouth. Jas had already begun to zip up her jeans and rearrange her blouse, but it didn’t feel right to give up now, to send her back to the very same situation after only a brief exchange. The midwife’s art lies in knowing when a woman needs another dimension to her care, and I sensed that for Jas, words – or at least, the clumsy assurances I had offered – would not be enough. I knew there were only seconds until she retreated back to the lonely world she’d come from, folding her sadness and her baby to her breast. And then it came to me.

  ‘Jas,’ I said as she lowered her feet back down to the floor. She paused and looked at me, waiting to see what more, if anything, I had to offer. ‘I think there is actually something I can do for your wound.’

  She tilted her chin; the gesture was perfunctory, birdlike; a cursory invitation to elaborate.

  ‘You’ve been so active that, on second thoughts, there might well be some low-grade inflammation below your suture line.’ I was flannelling wildly, but it seemed to be working. Jas stilled as she listened to my ‘diagnosis’.

  ‘I’d like to give your wound an antimicrobial soak, to soothe the scar and reduce any harmful bacteria. It will only take ten minutes, and all you have to do is lie back and relax. Beena will be fine.’ I glanced at the child snuffling dreamily in her car seat amid the raucous lullaby of Triage.

  ‘I suppose I could stay,’ Jas said, ‘if you really think there’s something that will help.’

  ‘Absolutely,’ I replied, smiling. What I had in mind would have minimal clinical effect – in essence, it was little more than a wash and a rest – but I knew that the ‘treatment’ would certainly do no harm. I could avail myself of any
instrument or drug that modern obstetrics might have to offer, but in this case, suggestion and intent were likely to be much more powerful.

  I reached into a drawer at the bedside and laid out my materials on the top of the trolley: sterile gloves, two packets of gauze swabs, and a long plastic ampoule of wound-cleansing fluid. Performance has its own role to play in midwifery, and I felt Jas looking on with interest as I opened each pack. She lifted her top and undid her jeans once more, and tenderly, slowly, with a very deliberate sense of ceremony, I unfolded the ten cotton squares and laid them side by side along the line of her scar. When the wound was finally covered in a swathe of clean white gauze, I snapped open the ampoule and trickled its contents over the makeshift bandages until each thread of the fabric was saturated. Whenever I dress a wound in this way, I remember that this is an act of loving validation; every wound tells a story, and every dressing is an acknowledgement of that story – the midwife’s way of saying, I hear you, and I believe you.

  ‘There,’ I said, patting down each swab with the lightest of touches. ‘We’ll let that sink in now. I’ll pop out for a few minutes. You rest.’ I dimmed the light above Jas’s bed before I left the bay. As I drew the curtain, I saw her lying back with her eyes closed and her arms at her sides. The rise and fall of her belly was just visible beneath the layer of wet swabs. In this small corner of Triage, there was peace.

  I passed a quick ten minutes shuttling between the phone and the growing heap of incoming patients’ case notes. As I answered a call about a thirty-one-weeker in preterm labour and another from a woman who was sitting in a small pool of blood on the bus home from work, I was increasingly aware of the need to clear some beds for these and any other urgent cases that the early-evening rush might bring. I gave Jas as much of a rest as I could before returning to her bed space, where I found her snoring softly. Her hands still lay at her sides, but as sleep had come, her palms had turned upwards as if in supplication.

  ‘Jas,’ I said, kneeling to give her shoulder a gentle shake. ‘How are you feeling?’

  She opened her eyes. There was a moment while she registered this strange face, and the even stranger surroundings. ‘I’m OK,’ she said. She looked down at her belly and peeled back an edge of wet gauze. ‘This felt good. Thank you.’

  It felt good to me too, I wanted to say. The hospital seemed to be growing busier by the day; too many of my shifts had been passing in a frantic blur, and I was aware that my touch had become less gentle and my intention less clear. As older colleagues took early retirement or left to pursue less stressful jobs, younger midwives had flooded in, then quickly balked at the realities of life on the wards. This had left me sandwiched uncomfortably in the middle – not senior enough to know all the ropes, or junior enough to be given the benefit of the doubt if things went wrong. It was an uneasy feeling, and I struggled at times to see where I fitted into the system, and whether my presence was making a difference. To know, though, that I could still offer comfort, and could give a woman ten minutes of precious pause – this did feel good.

  Jas put herself together with practised efficiency; jeans up once more, shirt tucked, wet gauze folded in a neat pile at the bedside. She wouldn’t let me lift Beena’s car seat, nor would she accept my offer of clean swabs and painkillers for the road. I walked with her to the double doors of the department and watched her stride away with that same easy grace I’d noticed on her arrival. There were still many hours left in her day – and in mine – and we would both continue to bear our wounds as we worked; Jas with her cloth and spray, me with my gloves and gauze, each ploughing our own furrow of healing and pain.

  Notes on the Uniform

  A starched white dress, a fob watch dangling from a polished chain, a wide elastic belt cinched with a silver filigree clasp. Opaque tights, neatly laced shoes tied with identical double knots. The picture of a proud, efficient midwife. This was never me, although I often fantasise about the uniform I missed out on by twenty years, before the powers-that-be decided that staff would be much more productive (and cheaper to clothe) if they wore unisex tunics and trousers. The stiff-winged caps, the Call the Midwife capes: these were out, and a gender-neutral two-piece was in. This, we were told, was progress.

  My cohort of students were the first to be given the new, nationally decreed uniform. Regardless of the undeniable ugliness of the clothes, we rushed as a giggling mass into the classroom that had become our designated fitting room on a Friday a few months into our training. With its desks pushed to the walls and its wide windows looking out onto the bleak cityscape beyond, the room was freezing. Still, we couldn’t wait to strip off and try on our freshly starched uniforms ahead of being let loose on our first clinical placements. Although we howled at each other in our ashen-grey tunics and navy drawstring cargo trousers, there was no mistaking the pride we felt as we twirled and posed, enjoying the strange thrill of the stiff fabric against our goose-pimpled skin. We were a ragtag bunch, ranging in age from seventeen to forty-one years old, some living away from home for the first time, others balancing classwork with young families. Some of us were still plagued with acne, while others bemoaned grey hairs and grumpy teenagers, but for the first time, our uniforms made us just that: uniform; the same. We had walked different paths, but we delighted in our new, shared identity. Finally, we looked the part.

  As we would come to realise over the following weeks, a uniform is both an identifier and a cloak of invisibility. It allows the wearer to be seen as official, knowledgeable, respectable; and in doing so, it also allows them to slip without question or reproach into environments where someone in ‘civvy’ clothes would instantly stand out as an unwanted, even potentially dangerous, intruder. Roaming a ward for the first time, asking a total stranger if you can check her stitches: of course! (Cue sheet being drawn up, and knees dropping swiftly open to reveal the fresh aftermath of a forceps delivery.) Pressing the buzzer to a fifteenth-floor flat, and being met with the scowling figure of a seven-foot giant and his growling Rottweiler: Come in, sister, he won’t bite! (Cue the giant falling over himself to bring you tea and custard creams while you examine his girlfriend’s flushed, swollen breasts.) With each shift, we began to inhabit our uniforms and our world with greater confidence, and as we edged further into the throbbing heart of the hospital, we swapped our grey tunics for scrubs. This had the phenomenal effect of rendering us completely indistinguishable from the qualified midwives and doctors who worked alongside us – until, of course, we opened our mouths.

  I was in the middle of my second year of training when an opportunity arose to observe a day of gynaecological outpatient surgery. Although I had started to feel slightly less of a bumbling rookie, this smaller hospital was completely new to me, and even the thought of entering the theatres here filled me with panic. In my few stints assisting with Caesarean sections, I had been unable to shake the strong feeling of being completely, relentlessly, in everyone’s way. There were so many rituals and rules – touch this, don’t touch that, stand here but not there – that I feared I would never be at home in the theatre, never be comfortably casual enough to swap dirty jokes and holiday plans over a woman’s open abdomen, as so many of the senior midwives seemed able to do. Nevertheless, I turned up for my day of gynae surgery in my shiny new uniform, and was shown to the changing rooms by one of the staff nurses.

  ‘This will be a quick day for you,’ she said as she left me to sift through the usual bins of oversized scrubs. ‘Dr Munn fires through them on a Thursday so she can pick up her kids from nursery. Blink and you’ll miss it,’ she said with a wink, and she turned on the heel of her neon-pink Crocs.

  True to the nurse’s promise, the day got off to a flying start. In the cavernous theatre, bright lamps glinting off chrome trolleys and gleaming floors, the various staff – anaesthetist, nurses, assistants and auxiliaries – gathered for the start of the show. At one minute past nine, Dr Munn appeared in her scrubs, gloved hands held aloft to avoid contamination, and her f
linty blue eyes danced behind her glasses as she announced to the waiting crowd, ‘Keep up, guys and gals. We’ll be out of here by three.’ I hung back against the wall, spectating from a safe distance while the day’s first case was wheeled in. She was young, and already anaesthetised, and I watched goggle-eyed as the doctor powered up her suction and quickly removed what remained of a missed miscarriage from the patient’s uterus. Job done, patient out. Next: an older woman with a cyst. Trolley in, cyst out, wound closed, patient out. I crept closer and closer to the operating table as the day went on, until finally the last person on the list was brought in: a woman in her mid-thirties with endometriosis. It was to be a laparoscopic procedure, where Dr Munn would slide a camera and any other necessary instruments through keyhole incisions in the patient’s abdomen, and blast away the offending tissue.

  With the same brisk efficiency I had now come to expect, Dr Munn approached the operating table for the sixth time that day, opened the patient’s belly and plunged the camera inside. As the doctor’s arm lunged and swung, moving the laparoscope here and there, her eyes remained firmly fixed on a nearby screen, where the patient’s internal organs were projected in vivid close-up. There was a glimpse of the smooth, pink uterus, suffused with tiny thread-like veins; a flash of the ovaries, like polished almonds; and then a longer look at the wayward fragments of endometrial tissue, small anemones that seemed to vaporise under the ministrations of Dr Munn’s mini blowtorch. After only a few minutes of this pelvic slash-and-burn, Dr Munn nodded at the screen, satisfied with her handiwork, and then she peered at me for the first time over the sleek chrome frames of her glasses. She didn’t know my name or the level of my training; she hadn’t asked. She’d seen the scrubs – and that was enough.

  ‘Come on over and I’ll show you a few things,’ she called.