However, the baby was another matter. He hadn’t been weighed, but my guess of between one and a half and two pounds was accepted. They all said twenty-eight weeks was barely viable, and that a living baby of that gestation must have hospital treatment, with the latest technological equipment, and twenty-four hour expert nursing and medical care. They suggested that he should be transferred at once to Great Ormond Street Hospital for Sick Children. Len looked dubious, but when they told him that without such care the baby would die, he readily agreed.
We all went upstairs to the bedroom. I don’t know what these hospital doctors thought of having to squeeze past all the prams in the hallway and parting the washing flapping around their heads as they climbed the wooden stairs. Nor did I ask. But I smiled to myself.
Conchita was sleeping, the tiny baby lying on her chest. One hand was protectively over it, the other lay limp by her side. She was smiling, and her breathing, although shallow, was regular and less rapid. I approached the bed and felt her pulse. It was slightly stronger, and regular, but still rapid. I counted 120 per minute, which, though abnormal, was an improvement. Liz was cleaning up quietly and efficiently, and the whole scene was peaceful.
The baby looked even smaller now that the entire hand of the mother covered it. Only its head was visible. It did not really look as if it were alive, although its colour did not suggest death.
The registrar wanted to examine Conchita. I told him that I had not yet examined the placenta, as I had not had time between delivery and the arrival of the ambulance. We examined it together; it was very ragged. “Not hopeful,” he muttered, “and it all came out at once, you tell me? I must have a look at her.”
He pulled back the bedclothes to examine her abdomen and see the vaginal discharge. Conchita seemed quite unconscious and didn’t move as he palpated the uterus. Some blood rushed out.
“Another pad,” he said, and, to the houseman, “Draw me up 0.5 cc of ergometrine for injection.”
He sank the needle deep into her gluteus muscle, but she didn’t move. He covered her and said to Len: “I think part of the placenta has been left behind. She may have to go to hospital for a D and C. It would only be for a few days but we cannot risk a haemorrhage occurring at home. In her condition it would be very serious.”
I saw Len turn white and he had to grab the back of a chair to prevent himself from falling.
“However,” continued the registrar kindly, “it may not be necessary. The next five minutes will tell if the injection is going to be effective.”
He then took Conchita’s blood pressure.
“I can hear nothing,” he said, and the three doctors exchanged significant glances. Len groaned and had to sit down. His daughter put her hand on his shoulder, and he squeezed it.
We all waited. The registrar said, “There is no point in examining the baby. It is obviously alive, but we are none of us paediatricians. Examination must wait for the experts.”
He asked for the telephone, to ring Great Ormond Street Hospital, but there was no telephone in the house. He cursed silently under his breath and asked where he could find the nearest phone box. It was two hundred yards down the road, on the other side. The long-suffering houseman was dispatched out into the freezing fog and icy roads with a pocket full of pennies gleaned from us all, to ring the hospital and make the necessary arrangements.
We continued waiting. There was no sign of an abdominal contraction. Five minutes slipped by. The houseman returned to say that Great Ormond Street would send a paediatrician and a nurse with an incubator and special equipment to collect the baby at once, although the time of their arrival depended on visibility.
Another five minutes passed. There was steady vaginal bleeding, but no contractions.
“Draw up another 0.5cc,” the registrar said. “We must give it intra-venously. There is something in there that has to come out. If we can’t get it this way,” he said to Len, “we will have to take her back with us for a scrape. And if you value her life, you must agree to this.”
Len groaned, and nodded dumbly.
I clamped the upper arm and endeavoured to pump up a vein for injection, but nothing showed. Her blood pressure was so low that the venous return could not be found. The registrar tried, with a couple of stabs, to locate the vein and on the third attempt blood showed in the syringe. He emptied the 0.5cc into her vein, and I released the arm.
Within a minute Conchita winced in pain and moved her legs. A large quantity of fresh blood spurted from her vagina, and then, mercifully, several large, darker lumps. There was a pause, then a second contraction. The registrar grasped the fundus and pressed the uterus hard, downwards and backwards. More blood and placenta were evacuated.
All this time Conchita was inert, but I thought I saw her hand tighten over her baby.
“That might be it,” said the registrar, “but we must wait a bit longer to see.”
He was more relaxed now and started chatting with anyone who would listen about the excellent golf down at Greenwich and the house he was buying at Dulwich, and his holiday in Scotland.
Over the next ten minutes there was no further blood loss, and no more contractions. Thanks to modern obstetrics, the danger of post-partum haemorrhage had been overcome for Conchita. But she still looked very ill indeed. Her breathing and pulse were rapid, her blood pressure abnormally low, and her temperature high. She did not appear to be conscious, although as her eyes were now closed, she might have been asleep. Nonetheless, her hand was still firmly placed over the baby, and any attempt to remove it was resisted.
With difficulty Liz and I cleaned up the bed again, and the houseman was given the messy job of checking the bits of placenta against the larger piece that had first been delivered, and measuring the blood that we had managed to contain.
“Placenta seems to be all here, sir, and I measure one and a half pints of blood. Add to that about eight ounces lost in the bed, and you could say around two pints of blood loss.”
The registrar muttered to himself, then said aloud, “She really needs a transfusion. Her blood pressure is already low. Can we do it here?” he added, turning to the GP.
“Yes, I’ll take a sample now for cross-matching.”
I had wondered why the GP had remained all the while, when he could have left. Now it became clear to me. He anticipated having ongoing responsibility for Conchita if she was to be cared for at home, and he wanted full cognisance of the facts.
At that moment the ambulance arrived from Great Ormond Street to collect the baby.
A PREMATURE BABY
It was a thousand pities, I thought, from the point of view of the good gossips of Limehouse, that all this had been carried out in a London smog. Had it been a clear night, every move would have been witnessed and reported - a midwife, police, teams of doctors, ambulances, each with a police escort. Such a sensation would have kept the gossips in business for a year at least. As it was, not even the next-door neighbour would have been able to see the two ambulances parked outside the Warren house, and police coming and going throughout the night. Their only consolation might have been that the whole street was wakened by the blood-curdling screams that lasted for about twenty minutes.
The paraphernalia and personnel that emerged from the second ambulance was overwhelming. A doctor came hurrying past, carrying an incubator. Another followed with a ventilating machine. A nurse followed with a huge box. Two ambulance men and the policeman came last, each carrying oxygen cylinders. All this equipment had to be manoeuvred past the three coach prams and two ladders lining the hallway. The washing hanging overhead didn’t help, because it got caught up on the equipment and several small, dainty items, personal to the young ladies of the house were transported upstairs. The children, who had been in and out of bed all night, hung over the banisters, and hid in doorways, to get the full impact of the procession.
On reaching the bedroom, the medical staff entered whilst the policeman and the ambulance men were directed down t
o the kitchen to join their colleagues for tea. Nevertheless, the bedroom, of average size, now contained five doctors, two nurses, a midwife, and Len and Liz. There was equipment everywhere. My delivery instruments still covered the dresser. The obstetrician’s was on the chest of drawers. The paediatrician’s had to be left on the floor, whilst we hastily cleared space.
“I think we’ll push off, now,” said the registrar to his colleague.” I’m very glad to see you. The mother is to be nursed at home. Good luck with the baby.”
They left, but the GP remained.
The paediatrician looked at the baby and gasped.
“Think he’ll make it, sir?” asked the young doctor.
“We’ll have a damn good try,” said the paediatric registrar. “Fix up the oxygen, and the suction, and heat up the incubator.”
The team got busy.
The paediatrician leaned over Conchita to take the baby. You could not tell whether she was asleep or semi-conscious, but the muscles of her arm tightened, and she held the baby fast.
He said to Len, “Would you tell her to let me have the baby, please? I’ve got to examine him, before we can transport him.”
Len leaned over his wife and murmured to her, trying to loosen her hand. It tightened, and her other hand came up to cover the first.
“Liz, luv, you tell yer mum we’ve got to ’ave the baby, to take to hospital.”
He shook her gently, trying to waken her. Her eyes flickered, and opened a little.
Liz bent over her and spoke to her in Spanish. None of us could tell what she said. Conchita opened her eyes more, and tried to focus on the little creature lying on her chest.
“No,” she said.
Liz spoke to her again, more persuasively and urgently this time. “No,” said her mother.
Liz tried a third time.
“Morirá! Morirá!” (He will die.)
The effect on Cochita was dramatic and immediate. She opened her eyes wide, desperately trying to focus on the people around her. She saw the equipment and the white coats. I think her clouded brain took it all in and she struggled to sit up. Liz and Len helped her. She looked wildly round at everyone, thrust the baby down between her breasts, and folded her arms over him.
“No”, she said. Then repeated louder, “No.”
“Mama, you must,” said Liz softly. “Si no lo haces, morirá.” (If you don’t, he will die.)
Conchita’s face was blank with anguish, but something was going on in her mind. One could almost see her struggling to get her thoughts under her command. Struggling to think, to remember, she held her breasts and the tiny baby fast, and glanced down at his head. The sight of it must have been the catalyst that brought it all together for her. Her mind seemed to clear, and a fierce, determined look came into her huge black eyes.
She looked round at each of the people in the room, her eyes finally clear and focused, and said with perfect confidence: “No. Se queda conmigo.” (He stays with me). “No morirá.” Then, with more emphasis: “No morirá.” (He will not die.)
The doctors didn’t know what to do. Short of tearing her arms apart with brute force, which Len would not have allowed, and grabbing the baby, there was nothing they could do.
The paediatrician said to Liz, “Tell her that she can’t look after it. She hasn’t got the equipment or the know-how. Tell her the baby will be taken to the finest children’s hospital in the world, and will have expert treatment. Tell her he cannot live without an incubator.”
Liz started to speak, but Len stepped in, and showed his true strength and manliness. He turned to the doctors and nurse.
“This is all my fault, an’ I must apologise. I said the baby could go to hospital without consultin’ my wife. I shouldn’t ’ave done that. When it comes to the kiddies she must always ’ave the last word, she must. An’ she don’t agree to it. You can see she don’t. An’ so the baby’s not goin’ nowhere. He’ll stop ’ere with us, and he’ll be christened, an’ if he dies, he’ll have a Christian burial. But he’s not goin’ nowhere without ’is mother’s consent.”
He looked at his wife, and she smiled and stroked the baby’s head. She seemed to understand that he was on her side, and the battle was over. She looked at him with confident love, and said quietly, “No morirá.”
“There you are,” said Len buoyantly, “he won’ die. If my Connie says that, then he won’t die. You can take it from me.”
And that was that. The doctors knew they were defeated, and started to pack up their equipment.
Len graciously apologised a second time, thanked them for the trouble they had taken, and said again that it was all his fault. He offered to pay for the expense of the ambulance, and the time of the medical and nursing staff. He offered them a cup of tea in the kitchen. They declined. He gave them one of his winning smiles and said:
“Go on, ’ave a cup. Yer got a long journey and it’ll warm yer.”
He had such an engaging way about him, that everyone agreed to accept the hospitality, even though they were cross about the wasted journey.
He and Liz helped the team downstairs with all their equipment, and the GP and I were left alone. He had hardly spoken during the past three hours or so, and I liked him for this. We knew that we had a huge responsibility, and that both mother and baby could still die. Conchita’s condition had been serious, but now, with the loss of two pints of blood, it was critical.
“She must have blood,” said the GP. “I have taken a sample for cross-matching, and as soon as the blood bank can supply it, I will set up an I.V. We will need a district nurse to stay with her while it is going in. Can you Sisters provide one?”
I told him I was sure of it. He said, “I’m going to start antibiotics at once, because she is breathing only into the upper lobes. I would like to listen to her chest, but I doubt if she will let me, because of the baby.”
He was right - she wouldn’t. So he drew up an ampoule of penicillin and injected it into the thigh.
“She must have one ampoule I.M. for seven days b.d.,” he said, as he entered it on the notes, and wrote out a prescription.
“Now I’m going to try to see about this blood. That’s as much as I can do at present. Frankly, nurse, I don’t know what to do about the baby. I think I will have to leave it to you and the Sisters. They are sure to have more experience than I have.”
“Or me,” I said. “I have never handled a premature baby before.”
We looked at each other with shared helplessness, and he left. Bless him, I thought. He hadn’t had any sleep for God knows how long; it was about 5 a.m., it was a filthy morning; and now he was leaving, on foot in thick fog, to try to get the blood sorted out. No doubt he had a surgery at 9 a.m. and a full day’s work after that.
I was so tired I could scarcely think. The adrenalin had been pumping all night, and now my body was drained. Conchita was sleeping; the baby could have been alive or dead for all I knew. I tried to think if there was anything I could do, but my brain wouldn’t work. Should I go back to Nonnatus House? How could I get there? The policemen had gone, and I couldn’t face the prospect of cycling alone in the fog.
Just then Liz came in with a cup of tea.
“Sit yerself down, luvvy, and ’ave a rest,” she said.
I sat down in the armchair. I remembered drinking half a cup of tea, and then the next moment it was daylight. Len was in the room, sitting on the bed, brushing Conchita’s hair and murmuring sweet nothings to her. She was smiling at him and the baby. He saw me waken and said, “Feel better now, nurse? It’s ten o’clock, an’ it said on ve news tha’ the fog’ll start to lift today.”
I looked at Conchita who was sitting up in bed, the baby still between her breasts. She was stroking his little head and cooing to him. She looked pathetically weak, but her skin colour and her breathing had improved. Above all, her eyes were still focusing and she looked collected. The delirium from concussion had quite gone.
From then on she improved rapidly. No doubt
the penicillin helped, but alone it could not have effected the astonishing transformation, within a few hours, from someone close to death who didn’t even know her own husband, to a calm competent woman who knew exactly what she was doing and why.
I have a theory that it was the living baby that cured her, and that the crisis had occurred when she thought that they were going to take him away. In that moment, her powerful maternal instincts had kicked in, and told her that she was the protector, the provider. She didn’t have time to be ill. She couldn’t afford to be woolly minded. His life depended on her.
Had the baby died at birth, or had he been taken away to hospital, I think Conchita would have died also. The animal world is full of such stories. I have heard that a sheep or an elephant will die if the baby dies, and live if the baby lives.
The level of consciousness or unconsciousness is also deeply interesting. Having sat with many dying patients over the years, I am not at all convinced that what we call “unconscious” is anything like the state of unknowingness we think it to be. Unconsciousness can be profoundly knowing, and intuitive. Conchita had seemed quite unconscious, yet her hand tightened over her baby when the paediatrician tried to take him. She could not have seen who was in the room, because her eyes were not focusing, nor known what had been said, because she did not understand the language. Yet somehow she understood that they were planning to take her baby away, and she fought back with every ounce of her strength. This had cured her.
Douglas Bader, the Battle of Britain flying ace, tells a similar story. After an air crash and bi-lateral mid-thigh amputations, he heard a voice say, “Hush, a young airman is dying in that room.” The words focused his mind, and he thought, “Die? Me? I’ll bloody well show you.” The rest is history.
Conchita reached for a saucer at the side of her and began to squeeze her nipples, pressing out a few drops of colostrum, which fell into the saucer. Then she took a fine glass rod which was used by one of her daughters for icing cakes. She held the little baby in her left hand and, having suspended a drop of colostrum on the glass rod, touched his lips with it. I watched, fascinated. His lips were no bigger than a couple of daisy petals. A tiny tongue came out and licked the fluid. She repeated this about six or eight times, then tucked him back between her breasts.
The Midwife Page 32
