THE BOTTOM DROPPED OUT OF PIGS 22 page

of nearly three hours. However, a registrar, a houseman, and a nurse from the obstetrics department had been sent by the hospital.

Everything happens at once, so they say, and within minutes a GP also arrived on foot. God bless him, I thought. He looked exhausted. He had been working all day and all night, and very likely most of the night before, yet he had the professionalism and the courtesy to apologise for being late.

With so much medical know-how in the house, it was necessary to have a case conference to decide the best course of action for mother and baby. We went down to the kitchen for this, and I asked Len to accompany me. Liz

was left with her mother and the baby. The two ambulance men and the policemen joined us too - they couldn’t be asked to sit outside in the cold, and there was nowhere else for them to sit in the house. Sue, one of the older girls, made tea all round.

I gave my case history, and handed over the recorded notes. All doctors were agreed that mother and baby must be transferred to hospital at once. Len was alarmed.

“Does she ’ave to go? She won’t like it. She’s never been away from home before, she hasn’t. She’d be lost an’ frightened. I knows as ’ow she would. We can look after ’er. I’ll stop at home, an’ the girls can muck in an all,

till she’s better.”

The doctors looked at one another and sighed. Fear of hospital was commonplace. Among the older generation, it arose mainly from the fact that most of the hospital buildings were converted workhouses, which had been feared more than death itself. The doctors agreed that as Conchita was now safely delivered, if no post-natal complications arose, she probably could be treated at home. A course of antibiotics would clear the infection that was causing fever. The head injury, causing concussion and delirium, would heal with rest and quiet. They tried to point out that she would get more rest in hospital than at home, surrounded by

children, but Len would have none of it, so they capitulated.

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 eèfficiently, 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 ye 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 Stree 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 to 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.

Len said: “She’s bin doin’ this every ’alf ’our since six o’clock. Then they both ’ave a little sleep, an’ she does it agen. She said ’e won’t die, and ’e won’t, yer know. She knows ’ow to look after ’im.”

I checked that she was not bleeding unduly, and left. I had to get back to Nonnatus House to report, and to request a district nurse to monitor the blood transfusion when it arrived. The smog was beginning to lift, and one could just about see across the road. It felt as though the world was filling with new life as the foul smog cleared, and I cycled back with a light heart.

Sister Julienne herself prepared a huge breakfast of double bacon and eggs for me “to keep the wolf from the door”, as she put it, and then took my report in the dining room whilst I was eating. She said, “I have never cared for such a premature baby myself, but a Sister in one of our other Houses has experience. We will consult her. Conchita will have to be watched very carefully for further blood loss.”

She found the whole story astonishing, and said, quietly, “God’s will be done.” She then went away to make arrangements for covering the blood transfusion.

Conchita didn’t lose any more blood. After the transfusion colour

returned to her cheeks, and also to Len’s. She was weak, but all danger had passed. The baby lay on her breast, day and night, fed in the manner that I have described about every half hour. All the lay staff and Sisters from Nonnatus House came to see the two of them, it was such a beautiful and unusual sight. On the fourth day I weighed the baby in a handkerchief. He was 1 lb. 10 oz.

After three weeks, Conchita began to get up for short periods. I had thought ahead, and had wondered what would happen to the baby. Obviously Conchita had also been thinking ahead, and knew exactly what was to be done. She had asked Liz to acquire from the dressmakers several lengths of the finest

unbleached silk. With the help of her skilled eldest daughter, she fixed a kind of sling or firm blouse around her shoulders and breasts, tight underneath, but loose above. The baby was carried in this for five months, between his mother’s breasts, never leaving her.

Who had taught her this? I have never before or since, in any literature, heard of such a way of caring for a premature baby. Was it purely maternal instinct? I remembered back to the delivery, and to her monumental struggle when they tried to take the baby. I had the impression then that she was trying to think, trying to remember something; and the sudden clarity and conviction with which she said, ” No morirá.”

Had she remembered seeing a peasant or gypsy woman carrying a tiny premature baby like this when she was a child in Southern Spain? Had this fleeting memory of times half forgotten been the cause of her conviction that her baby would not die?

Some years later, when I was night sister at the Elizabeth Garrett Anderson Hospital in Euston, I cared for several premature babies of about the same gestation and weight. They were all nursed in incubators, and I do not remember any fatalities. The hospital staff prided themselves on the excellent modern care which preserved the life of the baby. The hospital way, and Conchita’s way, are poles apart.

Incubator babies are alone, day and night, lying flat on a firm surface, usually in strong light. Only hands and clinical equipment touch the baby. Food usually comes as formula cow’s milk. Conchita’s baby was never alone. He had the warmth, the touch, the softness, the smell, the moisture of his mother. He heard her heartbeat and her voice. He had her milk. Above all, he had her love.

Possibly today, her decision to refuse hospitalisation for the baby would have been over-ruled by Court Order, the assumption being that only trained staff and advanced technology can adequately care for a premature child. In the 1950s we were less intrusive into family life, and parental responsibility

was respected. I am forced to the conclusion that modern medicine does not know it all.

Admittedly Conchita was lucky. The speed of delivery might have caused brain damage to the baby, but this did not occur. Apart from that, the great danger for a premature baby arises from immature vital organs, especially lungs and liver. The baby did indeed become very jaundiced, more than once, in the first few months, but each time it passed. It was a miracle, after I had heedlessly left the baby in a kidney dish, that his lungs were not wholly, or even partly collapsed from birth. I can take no credit for that. However, the fact is, he breathed. I like to think that by holding

him upside down, and tapping his fragile back with a finger, I facilitated his first breath. His mother was advised to do the same after each feed, because, if fluid enters the trachea, a premature baby cannot cough as a full-term baby would. She was also given a very fine suction tube, and shown how to use it.

Apart from that, which was very little, the baby received no medical treatment. The constant temperature of his mother’s skin kept his body temperature stable. Possibly the constant rise and fall of her breathing helped him over the first critical weeks. I am sure that her feeding policy - a few drops of breast milk placed on the lips at frequent intervals - was the right one. She even

did this all through the night, I was told. Conchita took no precautions about sterilising her feeding equipment. I doubt if she had ever heard of such a thing. The saucer and the glass rod were simply wiped clean after each use, ready for the next time. The baby survived. Either he is the ultimate survivor, or we put far too much emphasis on technology and techniques, I thought.

We visited three times a day every day for six weeks, then twice a day for a further six weeks. Domiciliary care was good in those days. At four months he weighed six and a half pounds and was responding with smiles, and turning his head. He reached out a tiny hand to grasp a finger. He gurgled and chuckled

to himself. I was told he hardly ever cried.

Several times in those post-natal months I thought of that dreadful night when he was born, and remembered Sister Julienne’s words to me as I left. “God be with you, my dear. I will pray for Conchita Warren and her unborn baby.” She had not just said that she would pray for Conchita. Nor had she assumed that the foetus would be born dead. She had said, with equal emphasis, that she would pray for them both. In fact, she prayed for us all.

Date: 2016-04-22; view: 822