In Falling Snow Read online

  “We went to the wards then. Sepsis was everywhere. He gets away with it because they’re closer to the front. You expect higher mortality, but even the most rudimentary analysis would probably show him up.

  “I tried to speak to him again, told him the successes we’ve had with gas gangrene and Elsie’s lab, invited him down to spend some time with us.” She sat down in her chair and shook her head. “He thought I wanted him to come down and teach my surgeons. ‘I would love to, Frances,’ he said, ‘and I know you girls are struggling, but I’m needed here.’”

  I could see Miss Ivens was tired and needed to talk. “So what did you do?” I said.

  “When we’d finished the rounds, I was blunt with him. I told him he must find a matron trained in Nightingale’s methods who could manage his theatres properly. I told him he must start washing his hands and make his surgeons do likewise. I told him he must don a mask, boil instruments. Such basic care, Iris. I couldn’t believe I was having to say it. For if you don’t, I said, you are killing patients of sepsis. Look around you.”

  “What did he say?”

  “He asked me was I questioning his practice. I wanted to avoid a confrontation but more than that I wanted to see something done. I said, I am pleading with you to consider what you’re doing. I will send you some papers. He laughed. ‘Papers,’ he said. ‘What on earth do I need with those? Chaps who’ve never seen the inside of a patient telling me how to operate. Pah. Mr. Lister and his idiot germs. I’ve got more important things to worry about.’ Do you know, the awful thing was that in another context I’d have liked him? He’s a jovial man, quick to laugh, more accepting than most of women in the discipline.

  “I didn’t know what to do then. I should have felt proud of Royaumont, of how different we are, what we’ve achieved. But I just felt sick, and I’ve been feeling sick ever since. For surely I’m guilty of just as much arrogance and I’m making similar errors. Not with hygiene, perhaps, but something else. Something I don’t know, some ignorance.

  “It suddenly occurred to me as we said good-bye outside the hospital—we were curt now and far from friends—that we’ll never know all things, that we’ll do more harm despite our oath because of ignorance, or arrogance.”

  Thinking back later on poor Miss Ivens’s worries about the state of medicine, I knew the things I might have said. You’ll never be like him. Your humility shines through all you do. You have no arrogance. Tens of things I could have said but didn’t. I just started going through the day’s mail and said, “I’ll draft you a letter to the Service de Santé. For you must write now and lodge a formal complaint.”

  About half an hour later Mrs. Berry joined us. Miss Ivens had cheered herself up by talking about what happened, first to me and then to her dear Berry, who knew just how to jolly Miss Ivens out of any bad mood. The cesspits had caused problems again. It was repairable, Mrs. Berry had told us, but the terrible stench around the entrance to the abbey would continue for at least another day. “But fear not, dear chief,” Mrs. Berry said. “Your faithful servants Berry and Iris have the matter in hand, so to speak.” We had the plumbers in again, fixing the cesspits, and the electricians, trying to give us more lights. It was never ending, the work to keep the old abbey functional.

  Now Miss Ivens was back onto the topic of surgery, completely cheered and ready to expound on why it was the best discipline. “You can do all the treating on the earth, spend weeks and months monitoring your patient, altering a dosage, changing a regimen. But with a single cut, you can transform someone, save a limb, stop a growth. Nothing else does that.” I felt, as I often did among the doctors, that they’d forgotten I was there. It was not an unpleasant feeling, for I learned much and was rarely put on the spot to respond.

  “Obstetrics,” Mrs. Berry said, taking a sip of her tea. “You should have stayed with obstetrics.”

  “Miracle of life, you mean?” Berry only shrugged. “Obstetrics is to surgery what Ping-Pong is to tennis. Surgery is power to change a life. I hate admitting that I want it, especially after I saw Crampton, but I do.” Miss Ivens noticed me then. “Listen to us going on, Iris. You’ll never want to be a doctor if I keep this up.” Miss Ivens had started to tell me I should be a doctor. I never took it seriously, but I was glad she’d cheered up and I smiled.

  “Iris will be all right,” Mrs. Berry said. “Women in her generation won’t have to worry. The battle will be over. They’ll be doctors and barristers and scientists and no one will think twice. Did you know, Iris, that Frances was a gold medallist at London University, and still they didn’t want her in the medical school.”

  “Even so, I wouldn’t have lived in any other time than my own,” Miss Ivens said. Mrs. Berry looked as if she might disagree, but Miss Ivens looked beyond us, out towards the cloisters. The sun was gone for the day and the orderlies were helping the patients back inside. Miss Ivens smiled. “How many women will ever have the opportunity to go from nothing to this?”

  “It wasn’t nothing,” Mrs. Berry said.

  “What?” Miss Ivens said.

  “What I had, nor you, I’ll warrant. We have families and lives back at home. They predate medicine. They’re worth something, Frances.”

  “Not like this,” Miss Ivens said. “Nothing in my life will be like this. Did I ever tell you that when I first registered, the medical board told me to forget surgery?” Mrs. Berry shook her head. “It’s not for women, one of the physicians said. You need to be stout of heart. He was nothing like as good as you, Ruth, with no idea of a woman’s fitness to practise. I looked him in the eye and said, I will be a surgeon, as if my saying it might be enough. Well, the College refused me that year and the next but finally, after three years, they let me into the surgery program. And once in, I had to wonder what on earth he’d meant. Surgery was different from general medicine, but stoutness was not the requirement. It was flight you needed, lightness and faith and nimble hands. I had none of those to begin with, but nor did any of them. We watched the surgeons and cultivated the skill of flight as best we could. I’d never do anything else. But of course, they never wanted us to practise. They let me into the program but told me all I could do was women’s health, never general surgery.”

  A breeze came through the window. We could smell the cesspits. Miss Ivens sniffed and smiled. “You did say they were fixing the problem, didn’t you, Iris?” she said.

  Just then Violet came in. “Frances, why is the queen of Serbia in the front hall?”

  “The queen of where?” Miss Ivens said.

  “Serbia.”

  “Oh yes, Elsie wired to say she was coming. Iris, I forgot to tell you. I don’t know what I did with the wire. We’re starting up another hospital in Serbia and the queen wants to see Royaumont. I hadn’t realised it was today. What date is it, Iris?” I told her. “Oh dear, she’s here on the right date unfortunately.”

  “What should I do with her?” Violet said. “This place stinks.”

  “I don’t know, find one of the doctors to take her round.”

  “Frances, you can’t do that. You’re the chief,” Violet said, exasperated.

  “Very well, I’m coming.”

  “Just before you go, Miss Ivens,” I said. “We’ve had advice from Paris after the last inspection. It concerns the pinard for the soldiers. The committee has written . . .”

  “Yes, Iris, thanks for reminding me. I fixed that.”

  “How do you mean?”

  “Well, the committee decided to give me a raise in salary since Royaumont is doing so beautifully. A hundred pounds, Iris! And it’s just enough to cover the cost of wine for the patients. So that’s settled. I couldn’t be bothered arguing with them this time, dear. Problem solved.” She smiled.

  Miss Ivens and Violet went off to deal with the queen of Serbia and I went to collect the day’s mail, holding my nose as I passed the plumbers at work.

 
Grace

  She was in theatre when her pager went off. One of the nurses went to check it. Alice. “She’ll have to wait,” Grace said.

  A few minutes later, Alice herself turned up. “We’ve got a failure-to-progress,” she said from the door.

  “So why are you coming to me?” Grace was supervising a D&C. She looked up briefly, saw the set of Alice’s jaw.

  “I want you to see her.”

  “I’ll be twenty minutes more here. Get Andrew.”

  “They don’t listen to him. It’s a tricky one.”

  Grace sighed. “What makes you think they’ll listen to me? Who’s the midwife?”

  “Chantelle Dupont.”

  Grace flicked her eyes at Alice again. “Tell me I didn’t get up this morning.”

  “You didn’t get up this morning. Will you come?”

  “Give me fifteen minutes. Get Andrew to work it up first. Failure-to-progress?”

  “Or something,” Alice said. Grace finished up in theatre and stopped at the office to call the medical library, hoping that by the time she finished they’d have sorted out the failure-to-progress. “Grace Hogan returning Katie’s call.” Grace had asked the library to do a search on the doctor named on Iris’s invitation to Royaumont.

  “Hi, Dr. Hogan. I’ve found out what I can about Violet Heron,” Katie said. “Dame Violet, I should say. She’s quite well known in Scotland, graduated University of Edinburgh Medical School in 1924, then did obs and gyn. She was a big advocate for reproductive rights for women, started the first birth control clinic in Scotland, got into lots of trouble with the churches.”

  “A woman after my own heart,” Grace said.

  “Well, she was still practising until recently, mostly reviews and reports for government on women’s health. The biggest was a national inquiry into abuse of children in care five years ago. Very outspoken. We’ve got some clippings from the inquiry if you’re interested.”

  “That’s great, Katie.”

  “She’s pretty full-on,” Katie said.

  “How do you mean?”

  “Imagine a little old lady walking at the front of a major protest march carrying an ‘Our Bodies, Our Choice’ placard and you’ll get the idea.”

  “Thanks, Katie. I’ll drop over when I can and pick up the clippings.”

  Grace left her pager with the desk staff and crossed the corridor to the birthing centre, a new maternity care unit run by a group of midwives. To preserve calm, doctors weren’t supposed to come in unless invited. They weren’t to bring their pagers. Grace opened the door of one of the rooms a crack and peered in. There was music in the background and the lights were dimmed. Andrew was there. “I just need to examine this woman quickly,” he was saying calmly.

  Grace opened the door fully and strode in purposefully. “Chantelle,” she said.

  Chantelle Dupont was a small middle-aged woman who always managed to make Grace feel inadequate, as if Grace were missing some key piece of information that would enable her to truly understand women and birth. Chantelle turned to Grace, then swung around and glared at Alice.

  “Failure-to-progress?” Grace took a pen out of her top pocket and put it back in.

  “We prefer to call it normal labour,” Chantelle said. Some midwives hated the term failure-to-progress because, they said, it implied the woman was failing. As far as Grace was concerned, it implied labour was failing, and sometimes it did. They talked about vaginal birth as a human experience. Grace had given birth vaginally twice. There was nothing human about it. She’d felt like an animal and not a cuddly one. “Alice asked me to review this case,” Grace said. She couldn’t see the chart anywhere.

  “This is Grace Hogan, Jen,” Chantelle said to the patient. “She’s a doctor.”

  “Talk to me,” Grace said, looking at Andrew and not Chantelle.

  “Elderly primip, failing to progress, she’s been at six centimetres for two hours. Foetal heart’s not great.” He flicked a look towards the head of the bed. The husband was sitting forward in an armchair holding the woman’s hand. He looked nervous.

  Just then one of the other midwives poked her head in the door. “Dr. Hogan?” Irritated at the interruption, Grace went over.

  “You just got a call from the office at Milton State School.”

  “What about?” Grace said.

  “Didn’t say.”

  “Tell the desk to call them back. Give them David’s number at the Mater.”

  “I didn’t even know you had kids.” The young midwife smiled. Grace had only told a few people at work about the kids. In her last job, at the Royal, so many people had been critical of her for working at all, let alone for pursuing obstetrics, it was easier to pretend she was childless.

  “Actually, it’s a bit tricky here right now.”

  “Sorry.” The girl left, the birth centre doors swinging closed behind her with a swish.

  Grace walked back over to the husband, still sitting at his wife’s side.

  “I’m Grace Hogan, one of the obstetricians,” she said. “We’re a bit concerned about your wife’s and particularly your baby’s condition. Can you tell me how long she’s been in labour?”

  The husband stood up. He was wearing track pants and a T-shirt. “Craig Wilson. The pains came last night. They said the baby would be born by now. She’s not herself. I keep telling them.” He looked towards Chantelle, who was smiling back at him.

  “Has your wife had any sleep?”

  “Nup. Me neither.” Men during labour. With some of them, you’d think they were the ones having the baby.

  “Excuse me.” Grace took the husband’s place at the head end of the bed. The woman was turned away from her, Chantelle on the other side of her. Grace spoke calmly to the woman. “Mrs. Wilson, can you hear me? We’re going to transfer you to the hospital and get you comfortable so we can deliver your baby. Do you understand what I’m saying?” Grace went to the other side of the bed to face the woman, forcing Chantelle to move out of the way.

  It was then that Grace realised.

  It was Jennifer Bennetts. Wilson, that was her surname now. Jen, Chantelle had called her. Jennifer Wilson. Grace felt her heart beating. Yesterday, in the clinic. Constipation. They’d given her suppositories. Did that bring on the labour early? Grace looked more closely. Jennifer Wilson appeared barely conscious. Grace checked carotid pulse, fast and weak. “Something’s wrong here,” she said. “Jennifer, can you hear me? Give me a torch.” Alice handed her one.

  Chantelle had moved around to the other side of the woman’s head now, level with Grace again. “We’re doing just great, aren’t we, Jen?” she said in Jennifer’s ear. Just then there was another contraction and Jennifer Wilson moaned.

  Andrew took the opportunity to check the foetal heart. “Not recovering well after the contraction,” he said evenly, looking at Grace. She knew he was keeping his voice calm in front of the husband but a foetal heart that wasn’t recovering after each contraction was worrying and the look on Andrew’s face said it all.

  Jennifer Wilson moaned. High blood pressure. That’s what it was. Grace remembered now. Jennifer Wilson had high blood pressure. There was no protein on a stick and Grace had ummed and ahed over a twenty-four- hour specimen. Protein—indicating pre-eclampsia—they might have found it with a twenty-four-hour urine specimen.

  Grace turned to the husband again. “I won’t pull any punches, Mr. Wilson. With more warning, we’d have moved to a caesarean an hour ago. We need to act now. I need you to consent to this on behalf of your wife. Now, Mr. Wilson.” Chantelle went to speak and Grace said, “Chantelle, step out right now.” There was no time to explain.

  “Jen,” Chantelle said, “they want to move us to the hospital,” as if Grace hadn’t spoken. Jennifer Wilson didn’t respond.

  Grace said to the husband, “Your wife is no longer capabl
e of providing consent. I implore you to understand. I saw your wife yesterday. You need to say yes right now.”

  “Craig, you have a right to—” Chantelle began.

  He looked away from Chantelle and towards Grace and nodded, almost imperceptibly.

  “We’re moving,” Grace said. “We’re moving now. Alice, get a gurney, let theatre know, get another consult and paeds.”

  Grace headed to the door and flicked on the fluorescent lights and then two things happened at once. Chantelle started coming towards Grace, speaking too loudly for the room. “This is a woman, a woman with feelings and views.” Grace turned and was about to respond by asking Chantelle to leave the room when Jennifer Wilson became rigid on the bed, fists clenched.

  “Where’s maternal BP?” Grace said to no one in particular, as she walked quickly back to the bed and pushed the button that called in the code.

  Alice was shepherding Craig Wilson towards the door. “In about thirty seconds, there will be about ten more people in the room. You need to wait outside.” Then, louder, “Mr. Wilson, we need to work now.”

  Chantelle sobbed quietly in the corner. “I can’t see where they’ve recorded BP,” Andrew was saying as Grace moved to clear the airway.

  “Can someone help me lift here?” Alice was on the other side. They rolled Jennifer Wilson onto the gurney.

  “Last BP was on admission twelve hours ago. It was normal,” Andrew said, cuffing the patient’s arm to take a measure. He looked at Chantelle. “You haven’t checked it since then? Hang on, yesterday it was one thirty over ninety. What was she doing here?” The crash team arrived as they were wheeling Jennifer Wilson out of the birth centre, across the wide linoleum corridor towards the theatre.

  As Grace left the theatre to go and talk to the husband, she was already thinking about what had gone wrong. The blood pressure wasn’t all that high when Grace saw Jennifer Wilson, and stress could have accounted for it. It had been normal the day before, it was normal on admission, if it had actually been checked, and then the birth centre midwives hadn’t checked it again, not wanting to interfere in the labour. None of it mattered. There was their history, hers and Jennifer’s, and there was Grace’s tiredness, chronic though it was these days, and her keenness to get away. And she couldn’t be sure. They hadn’t even confirmed Jennifer Wilson was pre-eclamptic, and foetal heart had been fine right up until those last minutes. You might not have picked it up.