Most of my shift had been really nice. That does happen sometimes. Maybe about once in 20 shifts. Just due to the random statistical distribution sometimes there are just not that many women going into labour.
I was on the antenatal ward and only had two women to look after. I was enjoying having the rare largess of an under-worked midwife. Chatting about birth-plans, oozing with bonhomie and various opinions on the use of syntocinon. I was feeling all smug and wise. Then one of the women said, “By the way, I just had to rush to the toilet,” which is a euphemism for diarrhoea.
So now is the problem of what I do. If someone in hospital has diarrhoea and vomiting that’s infectious (abbreviated to D&V) we need to isolate them and take certain measures. This has costs – side rooms are rare and in high demand, tests and a doctor’s attention is required, a woman with a baby in the special care unit may not be allowed to visit them. I have been warned off taking these measures for someone who probably just had a reaction to some medication or an attack of the nerves at being stuck in hospital.
Remember I’ve never worked as a nurse, D&V isn’t really my thing, although I guess no-one is that enthusiastic about it. So I asked an experienced colleague for advice.
The only problem was that the experienced colleague has a sick toddler, and has maybe slept 4 hours in the last 4 days. She looks at me tiredly, “well you need to decide if it’s likely to be infectious – it’s probably not – check if her stools are offensive,” and I feel yet again that the subtext is you’ve-been-a-midwife-long-enough-to-know-this-stuff so I leave it at that.
Eventually I find myself in the sluice room staring at a cardboard pulp bedpan which contains a small amount of liquid stool and quite a lot of urine that isn’t helping the decision-making process. On some levels it’s offensive – it’s a rare human that enjoys looking at someone else’s shit – but I think I’ve smelt worse. I try to scoop it into a sample pot but the there is too much urine and too little poo.
I decided that this issue is more medical than midwifery and bleep the doctor. I describe the scenario and the woman’s lack of any symptoms apart from diarrhoea. I don’t mention my five minutes spent examining it as I came to no conclusions and it makes me sound a bit weird.
I’ve worked with the doctor a couple of times, she’s new, normally friendly and helpful but she’s begun to suffer from the lifestyle and has begun to ration out her attention. “I don’t think this is appropriate for me to review – it’s probably not infectious but there must be a protocol to follow.”
I know some midwives who would immediately get angry and tell this doctor it is her job to make a decision but I don’t, probably because I’m too weak-willed for this job or maybe I’m just too nice. Or is that the same thing? Anyway I start to hunt down any protocols that seem appropriate but there are several and the shortest one is 48 pages long. Then an early labourer is admitted who needs all my attention.
So the easiest thing for me to do is just make the safest decision that she may be infectious. Put her in the last remaining side room and leave it for the next shift to sort out. Unfortunately this mean shunting down the next in line for the room – another woman who is on the edge of losing it because she hasn’t slept for 48 hours and can’t manage to in a 4 bedded ward.