The stuff of life
October 29, 2012 -- The remarkable new BBC series Call the Midwife, now airing in the United States on PBS, offers a dramatic look at the exploits of Anglican and lay nurse-midwives caring for poor women and babies in London's East End in the late 1950's. In the first three episodes, the series presents the midwives as skilled, autonomous health workers whose ability varies in accord with their relevant experience. Tough, expert senior midwives guide the nervous newer ones. In one early scene, after police try ineffectively to stop a raucous street fight between two women, one of the commanding senior midwives brings the altercation to a halt with one sharp question. The nurses visit pregnant women to monitor their progress, deliver the babies under awful conditions, and advise the new mothers, all in an environment without birth control where women seem to function as baby factories and one-person day care centers. One woman has 24 children. The midwives also provide community health services. Physicians do appear occasionally when their special skills are needed. But for the most part the focus is on the nurses who provide the vast majority of the care, and physicians are marginal, in what amounts to a reversal of the standard Hollywood model. Indeed, the show is remarkably free of stereotypes. It's not free of sentiment and generic uplift, some of the scenes are too pretty for the supposedly gritty setting, and central character Jenny Lee seems a bit unformed. The show is not quite on Nurse Jackie's level, and of course the setting differs greatly. But like Nurse Jackie, Call the Midwife is an often powerful, funny, and nuanced look at skilled nurses saving and improving lives in world whose concern for the health of the poor is open to question. Where Jackie offers regular critiques of the U.S. health care financing system, Call the Midwife includes advertisements for the U.K.'s National Health Service, which was new in the 1950's. Based on a memoir by midwife Jennifer Worth (nee Lee) and written by Heidi Thomas, the six-episode BBC series was a big ratings success in the U.K., and a second season is on order. In the United States, it seems to be doing well for a PBS show. We thank those responsible for Call the Midwife, and we urge all nurses to watch and support it.
Baby after baby
The series is mainly Jenny Lee's story and it is the older Jenny who provides occasional voiceover narration. As in Grey's Anatomy, the voiceover includes commentary about life, but here it's more about the wonders of the human condition or the young Jenny's inexperience, rather than advertisements for the main characters as tragic heroes.
At the start of the first episode ("Concussed, Nonplussed"), the young Jenny walks along the docks of East London, wondering what she has gotten herself into in her new job, reminiscing in her older-self-voiceover that she could have been an "air hostess," a model, or a concert pianist, but instead she chose this difficult path. Jenny comes upon two women locked in a nasty street fight, apparently because one of them had sex with the other (pregnant) one's husband. A raucous, cheering crowd surrounds them. The police arrive and ineffectively ask the women to stop. As Jenny backs away, a burly nun approaches; we'll soon know her as Sister Evangelina.
Sister Evangelina: Right. Which one of you ladies is my patient? [The fight stops and silence reigns.] Pearl Winston. Why am I not surprised? Constable, Mrs. Winston would appreciate your tunic. [The officer sheepishly gives his coat to Winston, whose dress has been torn open.] And don't get any blood on it!
Evangelina puts her arm around Winston and leads her away toward home. As she does so, the older Jenny resumes her voiceover.
Older Jenny: Midwifery is the very stuff of life. Every child is conceived in love or lust, and born in pain followed by joy, or by tragedy and anguish. Every birth is attended by a midwife. She is in the thick of it. She sees it all. I knew nothing of poverty or appalling housing, nothing of lice, of filth, of families sleeping four to a bed. And nothing of the passion that brings on baby after baby, labor after labor. I knew nothing of life itself.
Arriving at Nonnatus House, Jenny is greeted by Sister Monica Joan, who explains that they "are the Sisters of St. Raymond Nonnatus, midwives and district nurses, present at life's commencement and at its end." Sister Monica Joan has an unusual outlook; she says she is "attuned to feel vibrations" and she pressures Jenny to eat a great deal of cake before the others arrive.
Jenny soon meets Sister Julienne, who is the mother superior, as well as lay nurses Cynthia Miller and Trixie Franklin, and Sister Evangelina, who complains correctly that Sister Monica Joan is responsible for there being no cake. Sisters Evangelina and Monica Joan do not seem to get along. And Sister Evangelina displays what are arguably battleaxe traits, as she harshly seizes upon flaws in some of those around her. However, in contrast to classic battleaxes, Evangelina does not abuse patients and is in fact fiercely devoted to them--indeed, her toughness seems to be rooted in her high standards for care and her own apparent history of fighting her way out of poverty--and she is eventually revealed to be basically good-hearted. And in her stern authority, Evangelina resembles the formidable senior nurses in Ian McEwan's World War II-era novel Atonement.
Later, Sister Julienne explains to Jenny that Sister Monica Joan was one of the first English midwives, even though her family did not support that choice or her entry into religious life. Sister Julienne also tells Jenny that her personal faith is her own affair; some of them are nuns, but they are "all nurses first, and midwives foremost." The kind young Sister Bernadette enters, reporting to Sister Julienne that one patient's baby has "turned, no longer breech," and that she is only in early first stage labor, so Sister Bernadette "gave her chloral hydrate and left her to sleep." Sister Julienne explains to Jenny that a maternity box is sent to each mother's home two weeks before her due date, and they go over the tools Jenny herself will carry, including dressings, forceps, gauze sterile, gauze iodoform, an early stethoscope, enema funnel, enema syringe, and glass rectal tubes.
These introductory scenes established the midwives as skilled and autonomous health workers who provide vital care to those who need it. And the scenes make clear that the nurses are not unskilled angels, or necessarily linked to any religious tradition. That's important, because the show could have blended religion and nursing in a way that suggested nursing was really all about serving the Christian God, rather than an open, modern science profession.
Each episode of the show follows the care given to several patients. Early in this first episode, Sister Evangelina takes Jenny on a home visit to deliver a baby. On the way, Sister Evangelina notes that 80-100 babies are born each month in Poplar, their local area, and that will continue to happen until someone "invent[s] a magic potion to put a stop to it." At their patient's house, Sister Evangelina takes charge, addressing their laboring patient as she lies in bed.
Sister Evangelina: You, me, your mother, Nurse Lee. Anybody else coming up those stairs will have me to answer to.
This is the young patient's fourth baby, and she knows the process, though it's still difficult for her. When her water breaks, Sister Evangelina asks Jenny to change the bed. Jenny seems disgusted to find that there is newspaper under the sheets, but Evangelina tells her she's not in hospital with clean linen in the cupboards, and then impatiently gathers the paper and bedding herself. But Sister Evangelina is supportive as the birth progresses, noting that she can see the baby's head, asking the mother to turn her onto her side, and then asking Jenny to deliver the baby. Jenny advises little pushes, and she too narrates events for the mother, repeatedly telling her that she is doing well. The baby is born with no problems, and everyone is thrilled. Just then the faulty fireplace belches smoke everywhere. They all laugh, but the businesslike Sister Evangelina soon wonders why Jenny has delayed clamping and cutting the cord, noting that "sometimes we need to deal with what the Lord has sent us."
The most significant case in the episode is that of Conchita Warren, a tough, cheerful Spanish woman soon to give birth to her 25th baby. Jenny arrives for a solo home visit, and she struggles to get used to the conditions. Jenny examines Conchita and asks relevant questions, and since Conchita does not speak English, her less friendly older daughter translates. The daughter won't ask her mother when she last had a period. The English father arrives and helpfully explains that his wife hasn't had a period in years, just babies. Jenny estimates that the baby is due in 12-13 weeks, and she also says she is "supposed to" advise on diet and hygiene, though we don't see her do that. The Warrens don't seem to need much help.
When Jenny returns to see Conchita Warren, she is invited to join the family for a meal--which, to Jenny's surprise, means just tucking into a large communal pot with a spoon, no plates. Soon, we see Jenny heating something in a test tube, then telling the Warrens that because Conchita's ankles are swollen, Jenny must check for pre-eclampsia by "looking for signs of protein in the urine." That's a great example of technical expertise. Mr. Warren wonders if that condition is the same as toxemia, and Jenny confirms it is. Apparently Sister Bernadette told them earlier that you can only get toxemia with the first or second baby (which is only about 85% true, but that may have been the understanding of the day) and that the swollen ankles are due to Conchita being on her feet. Jenny asks Mr. Warren if he might persuade his wife to lie down for an hour a day with her legs slightly elevated. He'll says he'll have that done, but he can't do it himself because he never learned Spanish--he says they understand each other.
But before long, Mrs. Warren trips and falls while hanging her washing. She seems to have a concussion, and her husband calls Nonnatus House to report that she is also in labor. He tells Jenny on the phone that "it's you we need now, not [the physician]." We see Jenny tell Sister Julienne and Trixie that the water has not broken but the pains are every 5 minutes. Sister Julienne says that such a premature baby is unlikely to survive. She also reports that the "whole obstetrics flying squad" will meet Jenny at the house. Sister Julienne asks if Jenny has delivered a stillborn baby before. Jenny has with supervision, but she looks a little panicked, and Trixie offers to go with her. Sister Julienne says no, since she has a complex case to handle and presumably Trixie has to stay there on call. Jenny gets a police bicycle escort through the dense fog.
At the house, Mrs. Warren is screaming and out of control because of her head injury; they've never lost a baby before, her husband notes. Jenny tries to calm her, noting that "sometimes we have to deal with what the Lord has sent us." Jenny surmises that the concussion may be preventing Conchita from recognizing the pains as labor; she doesn't know what's happening and is too scared to cooperate. (No one seems to think to ask the older daughter to explain the situation to Conchita in Spanish.) Jenny says the urge to push will eventually take over, but in the meantime, Conchita screams and struggles. Jenny is fairly calm and she delivers the baby. He does look dead, but Jenny doesn't really seem to check and makes no evident effort to revive him. Jenny asks the oldest daughter for the bowl, apparently for the placenta, and also asks her to boil some water. Mr. Warren is worried about whether his wife will survive. Jenny admits that she is going into shock, so they need to keep her warm, and she's still losing blood, with a weaker pulse. Mrs. Warren asks about the baby; her husband says not this time. But then the baby starts to cry. It's alive. Jenny rushes to care for the baby. Conchita wants to hold the baby. Jenny sees that Conchita is still bleeding, and says that she needs specific medication. The flying OB squad arrives, and a commanding physician requests the same medication. But Mr. Warren actually asks Nurse Jenny what happens next!
Jenny: We need the rest of the afterbirth to come away, or the bleeding won't stop and she might need surgery.
A Dr. Turner arrives and introduces himself as Conchita's general practitioner. The take-charge OB physician tells Turner that they have a hemorrhaging mother and a viable neonate--and that "this young midwife" has been "very capable."
Turner asks if he can help and the OB asks him to "take over on the oxygen." He also directs a colleague to call the hospital and have them prepare for "a 30-weeker," and asks for the ventilator from the ambulance. Mr. Warren questions this, and Jenny notes that the baby will need help, maybe to be tube-fed. Jenny gets the afterbirth. Conchita and the baby seem to be stable. Mr. Warren says thank God. But the OB has other ideas.
OB: I'm all for giving medals to the gentleman upstairs, sir, but in this case, credit should go to the National Health. 10 years ago we'd have had none of this. No obstetrics flying squad. No ambulance. No chance.
Jenny: Placenta's complete, sir.
The OB is satisfied, and he says they can do a further transfusion for mom. He wants to take the baby to the hospital to "get him sorted out." But Conchita will not let the baby go. The OB says that Conchita needs penicillin, blood, and rest at home, and that the baby will be cared for in the finest children's hospital in England. Conchita says that the baby stays with her; she is his hospital, and he is her blood. Home he stays.
When Jenny and Julienne stop by later, Conchita is feeding the baby with a thin glass rod, which they call an "icing rod" every half hour. Then the baby goes back into her nightie. The midwives are impressed that he can take in milk because he is so young. Sister Julienne confesses that they have no experience caring for such babies, because they did not used to live, and now they are nursed in a hospital. Mr. Warren notes that this one will not be. Outside, Sister Julienne explains to Jenny that they will visit several times a day for six weeks, then every day for as long as needed. She says time will tell and they will see what "love can do." Later, Jenny weighs the baby and reports a 2-ounce gain, telling the happy parents that "we're on our way."
Jenny does display some expertise in these scenes, particularly in determining how the concussion may be affecting Conchita, in answering Mr. Warren's questions, and of course in delivering the baby. And we suppose the OB's praise is worth something. But in other ways this is not very impressive nursing. We won't fault the portrayal of Jenny's deference to the physician, which is probably realistic, especially for this time period. But we have to question her failure to check or try to revive the baby. And even if this might be understandable, since everyone assumed the baby would be stillborn, Jenny also seems clueless about how she might try to stop the bleeding of the mother. No one points this out, though, so maybe not much of the audience will see it that way. Also, the emphasis on Conchita helping her baby through "love" doesn't quite do justice to the concrete methods she is using, namely the kangaroo care and the frequent feeding, which are measures that nurses now often take the lead in promoting to protect neonatal health.
The other significant clinical plotline involves the unfortunate Pearl Winston, who took part in the street fight in the episode's first scene. While checking on Pearl at the clinic the midwives run, Jenny recoils at the smell; Pearl reports twinges and "shocking discharge." Jenny discovers a lump, which Pearl says has been there a while. Pearl deduces that Jenny thinks she has "a dose"--syphilis. Jenny retreats to consult someone more senior, and that seems to be Sister Julienne, who later approaches Jenny while she stands at a sink, furiously scrubbing her hands.
Sister Julienne: I'm afraid the lump in her vulva appears to be a syphilitic chancre. Other symptoms support the diagnosis. And of course the fetus is at risk. Dr. Turner is already on his way. I imagine he will prescribe a course of penicillin. Nurse . . . you won't catch anything.
Jenny asks how Pearl could have not known, or not cared. Sister Julienne says that Pearl "isn't accustomed to caring . . . or, indeed, being cared about." Jenny wonders how Sister Julienne can be so calm. Sister Julienne notes that when she was new to district practice, she often "found it hard to conquer [her] revulsion." Jenny apologizes, and admits that she didn't know people lived like this. Sister Julienne notes, in her calm but firm way, that "they do. And it's why we're here." Sister Julienne is a strong senior nurse--pleasant and kind, but also expert and authoritative.
Later, we see Jenny telling Pearl that Dr. Turner wants her to start the treatment right away and will want to arrange the same for her husband--the implication is that Pearl got the disease from him, and he in turn got it from the woman Pearl was fighting. Jenny gives the injection. Pearl says she should've been a stripper, because then she would've met "a better class of men."
Later, Jenny asks Trixie if she found the work hard at first. Trixie says at first she thought she deserved to get medals for being up all night, cycling to see patients, and so on, but she realized that "the mothers are the brave ones. Baby after baby in abominable conditions and they keep on going. They're the heroines. I'm just here to help." This is classic nursing self-devaluation, but it's better than it might be because the rest of the show clearly shows the heroism of the nurses.
Jenny's last visit to Pearl is not joyous: She has lost the baby. Pearl is sad, but resigned. She wants her milk dried up. Jenny says she knows and she has brought Epsom salts. Pearl clearly appreciates that, and she insists on making Jenny a "cuppa." Pearl figures Jenny must have a low opinion of the women around there. But Jenny insists she thinks they are all "heroines." Pearl smiles. However new and inexperienced Jenny may be, this is excellent psychosocial care.
The mark of a good nurse
The second episode ("The Browne Incident") continues Jenny's education in midwifery for the poor. Nonnatus House is busy, and so they get a new nurse: Camilla Fortiscue Chumley-Browne, or "Chummy." New to midwifery, large, awkward, and from an aristocratic background, Chummy quickly becomes a target of the pugnacious, poverty-born Sister Evangelina. But Chummy is an experienced nurse, friendly, decent, and self-deprecating; she ultimately proves to be fantastic with patients. Perhaps her biggest problem is that she can't ride a bike, which is essential for the midwives to get to the homes of their patients. The other midwives try to teach Chummy, but progress is slow, with some falling involved. Neighborhood kids mock her, and Sister Evangelina suggests that "the East End'll eat her for breakfast."
At the clinic the midwives seem to conduct for women in their care, we see two older pregnant women talking. One, Betty, feels awkward to be expecting a child as "the mother of the bride." The other, Brenda McKenty, has become pregnant after remarrying. In the examining area, Dr. Turner asks McKenty the standard questions. He also explains to Chummy that as a child, McKenty had rickets, because she was deprived of sunlight and malnourished. That resulted in a skeletal malformation and in the past caused her to experience obstructed labor; she had four stillborn babies long ago. Turner goes on to explain, somewhat cheerfully, that rickets was a disease of poverty, but now with the welfare state, it's become a disease of the past! This is insensitive and McKenty starts crying. Chummy comforts her, while Turner, somewhat confused, explains that now she can get surgery, free of charge.
Chummy (softly): Did you hear doctor, Brenda? This is a brand new baby, and a splendid chance for you. We're all here to help and doctor's going to help most of all.
McKenty sobs that she's making a show of herself, but Chummy says not at all, and gently suggests they should start by letting Turner look at her tummy. Trying to pass by the foot of bed at the same time as Turner does, Chummy bumps into a portable divider, knocking it and other things over, with some breakage. Evangelina, who is nearby, harshly says she hopes Chummy takes better care of the babies. But afterwards, Turner himself has a different take on Chummy's performance, as he makes clear to her.
Turner: Well done. You made Brenda McKenty feel safe. . . . It's the mark of a good nurse. A midwife too. Everything else is just mechanics. You'll soon get the hang of it.
This is a mixed portrayal. Chummy does display great psychosocial skills in calming the upset patient and getting her on track for the exam and the upcoming birth. And the physician endorsement is helpful because viewers will take it as authoritative, though it might be fair to ask how much Turner knows about making people comfortable, given his little pep talk about rickets. Chummy's comment that he will help "most of all" is unfortunate, as is the idea that he is in a position to tell a practicing nurse what makes a good nurse. And Turner's comment about "mechanics" could be read as an insult to nursing (is medicine also just psychosocial care plus "mechanics"?). But since he doesn't specifically link the comment to nursing, it could refer to health care generally.
The midwives seem to get some continuing education, since in a later scene, we see Sister Bernadette teaching Chummy and the other newer midwives.
Sister Bernadette: Approximately 3-4% of babies arriving at term are born "breech," that is to say the buttocks and not the head will be the presenting part.
Cynthia asks if Shakespeare hadn't described Richard III as being breech. Sister Monica Joan, who is observing, says that in Poplar they call it arriving "ass first." Sister Bernadette asks if the students have seen a breech birth. All have, and Chummy describes a midwife who let the baby dangle with its head still inside the mother's body. Sister Bernadette says that is done to "increase the flexion of the head." Sister Monica Joan says it also increases the risk of asphyxiation and is "a showman's trick in my view." Jenny asks how long the baby hung; Chummy doesn't know because she passed out.
This is generally good, because the nurses are learning, using clinical terms, debating birthing techniques--and at least one of them has read Shakespeare! Actually it's pretty clear that Chummy would also have had significant formal education. What she hasn't had is an education in the lives of common people. Sister Evangelina arrives at the class session to berate Chummy for chronic lateness, which happens because she can't bicycle and has to walk everywhere. The other midwives try to defend her, but Evangelina wonders why Chummy isn't doing something about the problem. In fact, her flailing efforts to learn to ride do continue, but they also lead to another crash--this time into a police officer.
At a meal, Sister Julienne says she is glad no one was seriously injured in that crash and that they are not all "up before the magistrates." Sister Bernadette wonders about that, since assaulting an officer is a crime. Sister Evangelina complains that Chummy got off scot-free (though she is apparently injured) and protests the idea that Chummy would be delivering babies by herself anyway. Sister Bernadette gently notes that cycling aside, Chummy is quite competent. Sister Evangelina says she has no experience of ordinary people. Jenny says they like her; Sister Evangelina counters that they laugh at her, and they've every right to do that because she's "no better than a tourist." Chummy arrives, having dragged herself out of bed to buy some whisky for the police! She laments that the liquor seller had never heard of the Glenlivet, but clearly Chummy is no amateur when it comes to human relations.
Later, while Chummy is on call alone at Nonnatus House, she gets the call that Betty is going into labor during her daughter's wedding. Chummy manages to get there on the bike, though she seems to have walked some portion of it. Jack, Betty's young son, mocks her as she arrives ("run for your lives!"). Betty wants no unnecessary attention to her labor, in view of her age and family situation. Chummy listens to her belly and concludes that the baby is breech, or as Chummy translates, "ass first." Chummy says that Betty is not quite fully dilated, so there is time to get to hospital, but Betty wants to stay in her own bed. Chummy steps outside, collects herself, and then orders all the kids downstairs, except her tormentor Jack. She tells him to call Nonnatus House for backup. Upstairs, Chummy asks Betty to change position, moving to the edge of the bed. Betty resists, but Chummy persuades her. In the midst of all this, we see scenes of wedding revelry. Chummy is visibly nervous, but she persists, saying she knows Betty wants to push, but the baby must come very slowly. Chummy advises a "little push," then "stop."
Chummy (nervously, but her eyes fixed on Betty): Bravo, Betty. Your baby's bottom is now delivered. Now . . . I need you to stay very still, breathe very calmly, as I hook my fingers . . . over her legs and bring them into the world.
Chummy delivers the legs. She tells Betty she will wrap the baby in a towel, though her head is still inside the birth canal.
Chummy: Now, with the next contraction, you may feel the baby move, as I turn her just a quarter circle, and that will help ease the shoulders out. . . . Well done. . . . I don't want you to move a muscle. I am going to loosen my hand on baby, and let the body hang. Not a muscle, Betty. (Louder, hearing Sister Evangelina and Dr. Turner arrive.) Can we have quiet for the mother, please.
Turner tells Sister Evangelina quietly that it looks as though Chummy is "managing things beautifully." Chummy tells Betty to push, and keep it coming. The baby is born and looks great, and there are smiles all around. Later, we see Sister Evangelina steadying Chummy's hand in cutting the cord, smiling and telling her simply, "You're all right." Chummy thanks her.
This is an excellent scene for nursing. An inexperienced nurse-midwife conquers her fears and provides great technical and psychosocial care on her own, delivering the breech baby smoothly, skillfully coaching and calming the mother despite her own nerves, and even "nursing out loud" by narrating what she is doing at every stage, so that those around her (and viewers of the show) learn more about nursing expertise. Even Sister Evangelina is impressed. Bravo, Chummy!
An older-Jenny voiceover reports that Chummy did finally master cycling, and that young Jack, of all people, became her "devoted guardian," and she was never taunted again. In fact, "unused to such kindness," Chummy bought Jack a bicycle from her generous personal funds, and we see them riding side by side! Older-Jenny also reports that Brenda McKenty had a healthy baby by Caesarian section, which could have saved her previous kids. And Jenny adds, in one of the show's subtle NHS ads, that the "National Health Service gave her the gift of motherhood."
The episode's other main plotline is darker. Early on, we meet a very young prostitute named Mary. Another prostitute at their brothel notices that Mary is pregnant, and notes that Mary will not be allowed to keep it. Mary steals some money and flees the brothel. She eventually comes upon the well-dressed Jenny in the street and asks for help changing the 5-pound note she has stolen. As they eat in a café, Mary describes her broken family and her journey to London from her native Ireland. Jenny takes Mary back to Nonnatus House, though she is shocked to hear about the prostitution. Sister Julienne wants Mary to stay with Father Joe, who runs a "refuge for girls like" her. Mary fears her pimp, who will force her to have an abortion, but she agrees to go if Jenny will accompany her. Mary assures Father Joe that she's not a "fallen woman," that she had a boyfriend named Zekiah, but then she was forced to work for his uncle--presumably the brothel owner. Later, Joe explains to Jenny that this is an old trick to lure girls into prostitution.
We see Jenny examining Mary, and advising resting and eating. Mary is reminiscing about what was good about sex with Zekiah. Jenny reminds her that "what Zekiah did to you was obscene, not beautiful." Mary says she can't help it because he's standing outside in the street, as he has been every afternoon. Father Joe is determined to get Mary away because she is too valuable to the brothel. So they move her to a "mother and baby home" in Kent, where the child can be delivered in "the cottage hospital." And for a time Mary is overjoyed with her new baby. But then Jenny learns that they have taken the baby away to offer it for adoption. Mary is beside herself. Jenny angrily tells Father Joe that Mary "has abscesses in both breasts; isn't her mental agony enough for them?" Father Joe says the babies are always placed for adoption "in these cases," in the child's interests. Jenny asks about Mary's interests, since she is the child's mother and did not consent. Joe says she can't consent, since she's only 15. He asks, reasonably, how a child like Mary with no home, no education, and no training except prostitution can raise a child? Without the baby Mary could get a job, find love, have another baby. Jenny returns to Mary, and explains that her blocked milk ducts have caused the infection. She says she will get antibiotics, and in the meantime she will bind Mary's breasts. In voiceover, Jenny says that Mary would never be reunited with her child.
Jenny does well providing the limited clinical care in this plotline, particularly in treating the blocked milk ducts. But mostly the plotline shows a more holistic effort to help Mary find a better life. Jenny gains Mary's trust and plays the key role in helping her to escape from her original situation, to have the baby she wants to have, and we might hope, to start a new life. Jenny also advocates for Mary, in an understandable way, though her advocacy is presented as misguided, if not naïve. And there is no happy ending, as the voiceover makes clear; we don't actually know what life Mary ultimately had. Surely, though, it was better for having met Jenny.
Removed from the care of district nurses
This episode ("Maybe a Baby") has far less of a clinical focus than the first two. Instead, it is mainly about the relations between the nurses and others in the community, with sprouts of possible romance for Jenny and Chummy.
One clinical plotline illustrates what the show calls "district nursing," which seems to mean providing general nursing care for the poor in the community. In this episode, Jenny Lee pays regular visits to Joe Collett, a likable and remarkably positive older veteran suffering ulcers on his legs due to old war wounds. Jenny is still getting used to working in poverty settings and she initially struggles with the conditions in which Joe lives. When she discovers a lot of vermin under some food they are about to consume, she is shocked and leaves very soon. Yet he calls it luxury to have a warm bed and plenty to eat. Later, Jenny describes the scene with the vermin to her nursing colleagues as if it was a horror movie. They try to be polite, but Sister Julienne tells Jenny that her own discomfort is not important, because they are there to provide nursing care.
Over time, Jenny strengthens and develops a real bond with Joe. She takes care of his legs, but she also provides great psychosocial care, talking about his life and his lost family (his wife and sons died in the world wars), and even taking him to a reunion of his old military regiment, the Scots Guards. But there is trouble when the government finally decides to tear down the squalid housing in which Joe has long lived. He doesn't want to leave. When he finally does go, apparently to a kind of nursing home, he still manages to keep his positive outlook when Jenny visits. But Joe's health declines quickly and the withdrawal of district nursing care plays a key role. As the older Jenny explains in voiceover:
Older Jenny: "Removed from his home and the care from district nurses, Joe could not be given the necessary care. His ulcers became gangrenous, and both legs had to be amputated at the knee. Joe died soon after his operation. There was no last post. No solemn drumroll. No final salute. Joe remembered me in his will. He didn't have to, for I would not forget him. I'd seen so many lives begin, but it was the end of his that opened up my heart."
Joe's sad story underlines (as few television plotlines do) what happens when skilled nursing is missing or withdrawn--people die. The difference between life and death for this man, and millions like him around the world, is not a brilliant diagnosis from Dr. House or a brilliant surgery by Dr. Shepherd. It is skilled physiological and psychosocial care from nurses, whether in a community health setting or an institution. The plotline also shows the importance of the kind of sustained preventative care at which nurses excel, which, again, is not often seen in an entertainment media environment that favors flashy one-time interventions.
On the whole, Call the Midwife offers a compelling and enlightening look at how skilled nurses helped one particular needy community. It may be far removed in time and place from many viewers, but the vision of nursing it presents--that of a life-saving profession that requires scientific knowledge, interpersonal skill, and real toughness--is valuable no matter how different the viewer's own situation. We thank all those responsible for the show.
See the show's website, watch episodes online, leave comments for the show, or write to them directly at:
Call the Midwife
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