Prelude
We are fortunate in a place like Great Britain to presume that we will survive child birth, for the most part this presumption is reasonable, but for around a hundred women in the UK each year, this is not true. Some have illnesses that make them more vulnerable, some die because of the unexpected or unusual. Even those who look after women in pregnancy were shocked when they realised how many took their own lives because of profound mental illness related to pregnancy. Some die simply because they have given birth.
Jane was doing her first SHO job, frightened by how little she knew and unable to contribute beyond inserting Venflons, seeing endless emergency admissions before someone else made a decision and keeping up with the paper work. She was always the first to be called, but never the one to take action.
She had been on call for the weekend, eighty hours of continuous work during which she was allowed to sleep, but sleep was never guaranteed. She had not been permitted to sleep for more than an hour at a stretch for all three nights of her weekend; cumulatively, she had slept for seven hours. By Monday morning she was too tired to think straight, but she was back on delivery suite to do her regular session.
She remembered the woman well, she had been booked with the consultant Jane worked for. In her first pregnancy this woman had persuaded her obstetrician that she needed a caesarean section - she had a back problem and could not possibly labour. In her second pregnancy she did not have the choice, she had placenta praevia, her placenta lay over the cervix and up the front wall of her womb, embedding itself in her caesarean section scar. The Confidential Enquiries into Maternal Deaths warn wariness in these situations, even thirty years ago, Jane could see the anxiety this woman’s situation generated. The woman had been admitted to hospital at twenty-six weeks when she started to bleed. She did not bled heavily until she reached thirty-three weeks and Jane was struggling through her Monday morning. Things like this tend to wake you up, or perhaps you become too full of other things to permit your tiredness. The woman had to be delivered. The team was mobilised - the consultant and senior registrar performed the caesarean section, Jane scrubbed and stood, insignificant and unknowing, trying to keep all that blood out of the operating field. The woman bled her own blood and the numerous units of blood she was transfused. A hysterectomy was performed - Jane had been shocked that they had been willing to do this at a seemingly premature stage, though now she was experienced, in her heart she knew it should have been performed earlier. Even so, the woman continued to bleed. She watched the desperate efforts of her boss as she tried to stop the bleeding. They had to stop operating when the woman had a cardiac arrest and the anaesthetic team started cardiac massage. Thomas had been part of that team, he was a very junior registrar learning about obstetric anaesthesia. Jane had noticed that the bleeding reduced, until the woman’s heart started again, it had only been a temporary reprieve. No one wanted to acknowledge the futility of the situation, no one wanted to accept that this new mother would not survive and they fought futility and inevitability until the consultant anaesthetist told the team that the woman’s pupils were fixed and dilated.
Jane remembered how her boss had looked up, fixed the anaesthetist in the eye and then resumed her attempts to complete her surgery. She remembered the firm, but gentle voice of the anaesthetist, “Liz,” he had addressed her boss, “Liz, I’m sorry, she’s dead.” Even doctors need it spelling out sometimes.
Her boss had sat down on a theatre stool, removed her gloves and held her head in her hands.
The anaesthetic team saw that they had permission to cease resuscitation. Jane had stepped back in horror. She was a foot soldier, a minor part, not really required. She did not need to write operation notes, or to talk to the woman’s anxious relatives who waited outside. She was not needed to piece together and record the order of the events that had played out over the preceding three and a half hours. She did not need to ring the Coroner or the chaplain. Her version would not be required to complete the form for the maternal mortality report. She had slunk away to sit in the coffee room and it was there that Thomas had found her. They did not know one another then, but he had realised she considered herself too small a part to seek help.
He had sat quite close to her. “Are you OK?”
He asked that stupid question, but we are never able to find a more suitable opening gambit for such occasions. It was then that Jane had started to cry. Thomas had looked uncomfortable for a moment before he took her in his arms. Despite that which their relationship would become, this was not affectionate or sexual, it was simply a response to human need. Jane stayed there in his arms for about twenty minutes, still crying and it had been the senior registrar who had found them.
“Go home, Jane. I know you’ll need to talk about this, but there’s too much to do with the family right now, I’m sorry, you’ll have to wait until tomorrow.”
Jane had pushed Thomas’s arms away, stood and left the room, getting dressed without speaking to a single person. Thomas had watched her go.
