The Struggle For Air

To everything there is a season

And a time to every purpose under the heaven

A time to be born and a time to die...

Ecclesiastes 3:1

Things I never imagined. One.

A levels are cancelled.

GCSE's are cancelled.

In our house, that's the double whammy.

Twelve cumulative years of secondary education end abruptly at 3pm on a bright Friday in March. Books packed, bags packed, lockers emptied, PE kit salvaged. Drama and music practicals crammed frantically in to the last few hours. Lanyards and locker keys handed in at reception as the deputy head of sixth form apparently cries inconsolably. And that's it - school's out for summer. Or in my sixth formers case - school's out forever.

No prom, no dinner-dance, no chance to reminisce with teachers who have now become friends. No results day tears - of relief or frustration or joy. No chance to show what you've learned or to cram what you haven't. No exam-morning bacon butties in the science department. No sitting on the wall with your mates when it's all over, contemplating a summer of endless possibilities.

My reaction to the dramatic and unsettling events unfolding in my children's lives?

Largely oblivious.

I mean I realise that I am not required to make three packed lunches every day. And I do recall registering them for the keyworkers scheme, for which I receive a sharp rebuke. They are too old apparently and can look after themselves. I receive baffling texts from people saying how sorry they are about the exams and do I want to sign a petition? Well no, frankly, I don't. Because I don't have to make packed lunches. And that can only be a saving grace.

Because right now I can't think about sandwich fillings. I can't worry about homework, or the lack of it. I don't even think about brushing my hair or eating breakfast.

I am completely immersed in a maelstrom of events which consume me and become my only world.

My work, my beautiful fellow midwives and the women in our care.

All else is clutter and noise.

Things I never imagined. Two.

Some of my colleagues are shaking with fear.

Midwives are brave by nature. Wet face the bleakest outcomes, when there is no happy ending. We try to pick up the pieces when they are truly shattered. We have to hold it together. Hold ourselves together .We also know risk - it is our shadow. It walks with us throughout our working lives. We are constantly making judgement calls, balancing pros and cons; sometimes when we're tired and not at our best. We work in the most litigated-against medical speciality. We risk losing our registrations, jobs and livelihoods for errors or poor decision-making. But far worse is the fear of unintentionally causing harm to a mother or baby. We live in a constant state of reflection. Should I have noticed that sooner? Could I have acted earlier?

We reflect, we learn, we move on.

But we don't forget ; we know about risk.

But this is different.

This is an unfamiliar threat, an enemy from an unknown source, ( bats, birds?) and in the space of a week many of the health and social care teams we work alongside have seemingly battened down the hatches.

I pop down to the GP surgery on my day off to check that my weekly clinic can run as normal.

I don't get past the sliding doors.

STOP! DO NOT ENTER IF YOU HAVE NOT BEEN TRIAGED.

I have not, as it happens, been triaged.

I pull my scarf down and the practice manager recognises me.

' Oh sorry - you can come in. Just to get your equipment though. We're cancelling our clinics and working virtually.'

I look around at the empty waiting room. It was packed when I was last here. Had it been full of malingerers and the worried well? And if not, the commonplace ailments of ordinary times appear now to be diminished in the face of a more sinister and imminently threatening pathology. I pick up my clinic lists and leave. The names I am clutching are my patients. They are also women who find themselves pregnant in the midst of a global pandemic.

Pregnant women often have anxieties. They ask questions such as whether mozzarella on a pizza counts as soft cheese, or if it is safe to dye their hair. ( No and yes ). They never imagine asking if their unborn baby will die if they catch the virus which is invading and infiltrating every community and neighbourhood in our land.

I do my best to reassure them that there are very few reported deaths of young babies. But the nightly news bulletins are horrific. Scenes of overwhelmed Italian and Spanish hospitals, with lines of dying patients struggling for their last breaths in corridors cut to the latest death statistics, which are close to a thousand daily in our own country. I feel at a loss to comfort a woman who is carrying another human being - who feels responsible for another life. As if worrying for your own isn't scary enough right now.

But my immediate concern is that I have no clinic space - just a list of names and cancelled appointments. One by one my colleagues arrive back at the office, clutching their own lists and looking as stunned as I feel inside. We gather our thoughts and steel ourselves. We then engage on the unimagined task of completely restructuring and reorganising the antenatal and postnatal care of hundreds of pregnant women, to reduce their exposure to Covid 19.

This mammoth task takes us two full weeks. We work our annual leave, weekends and evenings. We use specialist guidance from the College of Obs and Gods to create our new schedules based on a risk- benefit analysis , the consequences of which will only be truly known in years to come. There will be collateral damage resulting from Covid 19. It will poke it's poisonous tentacles into our children's education, the provision of cancer services, the mental health and well-being of young people isolated in their bedrooms, and the now tanking economy which makes millions fear for their livelihoods.

When our plans are finalised, I can hardly take in what I see printed in black and white.

Women will not see a midwife in person until the 28th week of their pregnancy. A full two thirds of the way through. They will come to that appointment alone and we will be masked, aproned and gloved. The word 'midwife' literally translates from the Old English as 'together with woman'. So how can this be?

We call a team meeting. The antenatal class room is bright and airy but it's strangely hard to breathe. My chest feels tight. In an attempt at 'social distancing' the chairs are spread apart as far as they can be without one of us falling out the doors. It's not officially far enough. The NHS may have two metres of workspace per person, but only if everyone is not actually doing any work.

I notice I am not the only one finding it hard to breathe. My colleagues all look anxious and a couple are visibly distressed. It is hard to see them like this. . They are incredibly dedicated midwives who have devoted their lives to providing exceptional care to pregnant women, new mums and babies. The word 'heroes' is being bandied about in the press. But we don't feel heroic. We don't even feel brave. We know that despite the streamlining we will be giving hands on care to hundreds of women in our clinics and at home in the midst of a deadly pandemic, while most people have been ordered inside. We are told that our A&E colleagues can now recognise this disease as the ambulance doors open. The dry rasping cough and the struggle for air signal yet another patient whose life may very soon hang in the balance. The virus has preferences, but it cannot be described as fussy. We know that we will be exposed to the possibility of being that patient for whom the simple matter of retaining oxygen becomes a breath by breath battle. We know all of this. And we are terrified.

Some midwives across the Trust take unpaid leave, for very valid reasons. We are all at different places in our lives and Covid 19 is no respecter of that.

The rest of us just put our heads down, take a step into the unknown and hope we don't fall off a precipice....

Once the new plans are rubber-stamped, we pick up the phones and make the calls, expecting to run quickly down our lists.

Wrong.

By the end of day one we have ordered headsets from Amazon as our necks are bent sideways. Every woman we ring clings to the call as if ending it is akin to setting a life-raft adrift. All at sea, we are the port in a storm which is gathering strength by the day.

Their voices are also tight. They have many questions.

By day two, my feet are up on a cardboard box. I am silently dunking my Maryland cookie into my tea as I talk. And listen. The radiator next to me belts out heat because the hospital only has an 'on' and an 'off' switch and no thermostat. It goes off on May the 1st. It is 26 degrees outside. I open the window and angle the fan to my face. The NHS is some way from being carbon neutral. But for now we have other fires to fight.

By day three I have stopped wearing uniform and resort to scrubs.. It's too hot, I haven't slept and it's my annual leave. The nation seems to have organised itself into teams of sewing circles (called scrubhubs) and visor designers/makers ( who knew that could be a thing?) My scrubs are bespoke however. Designed and made for me by my friend Helen, they are edged in Trust colours and are therefore presentable enough to look professional while being as comfortable as spending the day in my pyjamas - like the rest of the nation.

I spend my days caring, explaining, advising, reassuring, and sympathising. Some women arrive at the clinic swathed in protective wrappings and the type of filtration masks we only use in ICU. I have to unravel them and release them from the mask so they can breathe again. I provide a simple substitute that allows them to speak. But they have trusted us enough to come. And for that I am grateful and honoured.

They ask many questions. Can I go to work? Must I go to work? Who can I ask to care for my children when I go into labour as my parents are self isolating? How do I claim benefits as I have lost my job? How do I access a foodbank? How do I recognise if my newborn has Covid 19? Can my family holiday to Torremolinos still go ahead?

Ahhhh…. Torremolinos. The Maldives couldn't sound more appealing. But it may as well be the far side of Jupiter for all the chances of actually getting there. It's hard to be an expert in the wide variety of things I am now asked about. Aside from our professional updates I glean much of my knowledge from Google, social media and the BBC news website, which is where I discover that if you do go to Torremolinos you will probably not get back again. Best not risk it, I advise sympathetically. Shame though - it really is lovely at this time of year.

And throughout all the hours, days and weeks of answering questions, not one woman ever asks the one about mozzarrella on pizza. Or hair dye. And that's a shame because they are important questions. Although I am beginning to understand that many important questions will remain unanswered, in the time of Covid 19.

Things I never imagined. Three.

We eat Easter eggs for lunch. Most days.

They say that this crisis will see all of us either thinner or fatter. As if there is nothing immutable left in this universe, even our shapes will change. Initially the weight drops off me. The wired feeling suppresses my appetite and I eat Easter eggs as a way of forcing something down. They seem to appear from nowhere, as if they are reproducing. Of course they are arriving from shops, businesses and charities as the lockdown forces closures. My favourite is a Charbonnel and Walker Champagne Truffle Egg tied in a pink ribbon which arrives from John Lewis with a tin of Lemon and turmeric biscuits. This is definitely from the luxury gift range, I think, as I unravel the bow. It will be nice to share with my colleagues.

I break off a piece of very thick milk chocolate which snaps in a deeply satisfying manner.

We are awaiting the arrival of PPE, which is promised. Currently we are washing our hands constantly - they are raw and sore. I wash my hands both before and after breaking into the egg, carefully drying the chaps between my fingers. But it is worth it. Every time I do it, it is worth it. Which is many times that day. I really do mean to share the truffles but by teatime there are only three left. I have five colleagues coming in next day. It wouldn't be fair. I decide to share the lemon and tumeric biscuits with them instead.

Sadly they don't like the biscuits. I admit they are an acquired taste. So I eat those as well.

Fortunately their own lunch is delivered in the form of two boxes of kitkat crunchie eggs which arrive courtesy of the Salvation Army. They do say an army marches on it's stomach, of course. We consider this essential fuel as we press on in our mission. We don't apologise or make excuses to ourselves or to anyone else. None of us thinks about making a packed lunch or stopping off at the Co-op on the way in. We are in a zone, a bubble, with each other. We are focussed and blinkered and we rely on being fed and watered by others.

We all arrive home at night in the same state. Dazed, drained and unable to switch off.

I strip off just inside the front door, ( much to the horror of my teens), bag all my clothes, put them on a hot wash and get into the shower. I leave all my belongings in the car overnight.

Slumped on the sofa and staring at the TV I see nothing. A G&T lands somehow in my hand. It's always my youngest son who brings it. He knows exactly how I like my G&T - just the right amount of clinking ice in a perfectly sized glass. We watch the news; the Covid news - there is no other. I don't take anything in. But some things I already know.

I know about the Nightingale hospital, built seemingly overnight at the Excel centre, to take in hundreds of patients when the NHS runs out of capacity. I know that nurses from areas such as Outpatients, who haven't worked on a ward for years, are now redeployed to ICU along with gynae nurses, physios, retired medics and nurses of all backgrounds and basically anyone who can get temporary professional registration under the emergency regulations.

They quickly learn to don and doff their gowns, masks and visors which seal them in for a twelve hour shift like a boil-in-the-bag fish. Given that PPE is now being talked about as the nation's most precious resource, and the reality that each change of PPE takes 20 minutes, the luxury of a loo break on ICU is a rare one. Apart from the wastage, the fact is that it takes six staff members to turn one patient, ( a crucial aspect of the treatment of Covid patients for which there are now Youtube tutorials). There just isn't the time for comfort breaks.

I make a mental note that should I be redeployed to ICU I will break a solemn and long-held pledge to myself which I renew every time I do the pelvic floor exercise talk. I will break my vow never to wear a Tena Lady-pant

Well there are some things I never could have imagined.

Things I never imagined. Four.

Women leave their homes, despite the lockdown, to come to our clinics.

This may sound like a no-brainer. You need a midwife; you go to a clinic. Except when you learn that A&E is virtually deserted. Even people with chest pain are taking a Rennie and going back to bed. Some don't wake up. The country's chief nurse has put out a press release pleading with parents to take sick children to hospital. There are cases of children requiring advanced resuscitation because their condition has deteriorated at home and their parents have been too terrified to take them to the emergency department.

But our patients place great faith in us. They continue to come to appointments which now take place at our hospital base. We repay their trust by organising our waiting rooms so that there are never more than two at a time waiting. Our wonderful secretary, Bonnie, who has been our backbone throughout this crisis, greets the women warmly and hands out sanitizer with the urine pots. She has smiling eyes and the kind of reassuring manner which puts even the most anxious women at their ease.

The women almost all ask after our own well-being as we lead them into the clinic room. We are really touched by this. Sometimes it can seem to us that everything has become a commodity - even healthcare. We are all consumers. The complaints department of any NHS trust is a very busy place. There was a period when we were told to refer to our patients as clients or service users. Thankfully we are permitted to call them patients once again. There is so much more to our relationship than a transaction or a contractual obligation. It wouldn't take a Florence Nightingale or a Mary Seacole to tell you that much.

But now, in the time of Covid 19, something special and precious is happening. Our patients are also 'with woman'. They are with us as we are with them. We tread this fragile path together. We are a tribe with a common enemy. And we all have our strengths and our vulnerabilities.

This is particularly evident when one sunny morning I print off the postnatal discharges and a twenty page document accompanies it , entitled, 'Preparing for your Gastric bypass surgery'. I presume someone forgot to press print last night after scrolling through their emails. I place the information on the desk by our computer and decorate it with crème eggs, mini donuts and a sprinkle of m&m's. I am not anticipating any one of us being granted time off for weight loss surgery any time soon. But I concede that it pays to be prepared.

The night before my first scheduled home visit I barely sleep. I can't finish my Weetabix and I lose my car keys. By the time I get to the office my chest is tighter than ever. It's the peak of the crisis and the death rate is still nearing a thousand daily. The carnage ripples out from the Capital, where grim accounts of the nature of those deaths are laid bare on the nightly news bulletins by traumatized and exhausted nurses and doctors. It is a narrative of inconceivable personal tragedy played out on a global scale. Mild innocuous infection becomes acute in the blink of an eye, causing critical breathing difficulties for which there is no effective treatment other than an oxygen mask or a ventilator. Turning the patient prone seems to help but other than that, it's watch, wait and pray for a miracle. They do come sometimes, but not often enough to calm my nerves.

I am already exhausted when I pull up to the house and don my newly-arrived protective equipment. At this point we have not been provided with visors so Andy cobbles together a makeshift one from my son's spare tree-surgery helmet. It's a hot day and I am already sweating as I ring the doorbell. There is no way of knowing whether Covid 19 infects the homes we visit - especially in houses of multiple occupancy. I try to smile with my eyes as the door is opened.

I soon discover that I am not the only one who's had a sleepless night. I have an ally. Like most of the other new mothers I go on to visit she's taking no chances. I get no further than the hallway before being offered a vat of sanitizing gel . My PPE is inspected and I confirm that I haven't visited any other houses that morning. I carry out my clinical tasks with some difficulty as my glasses steam up under the visor but I can't contaminate my gloves by wiping them. Slowly my anxiety lifts and, just as a new mother adapts to her new normal, I adjust to mine. And as I walk down the drive in the spring sunshine, freed from my mask and visor, I breathe easily again and remember that I really do love my job.

I arrive home that evening to a window of Rainbow paintings courtesy of my daughter. There is also a gift bag on the doorstep containing a very decent bottle of wine. The attached label reads 'thank you NHS worker'. I shed a few tears - mainly of relief. But also of pride and gratitude. I've seen 22 patients today, including the home visit. And I'm still here to tell the tale. Maybe this will be OK, I think, as the ice clinks in my glass.

It's then that I notice one of the messages in the window. Under a brightly painted rainbow is clearly written the words 'GIVE LOUISE THE CLAP!' I take a large swig of my G&T and order the immediate removal of the offending poster, amidst much sniggering. Bloody teens.

I flick idly through facebook. It's mainly petitions about PPE. I sign them all but I can't really concentrate on anything in detail. Then my eye is caught by a petition that is calling on Health Secretary Matt Hancock to allow a particular pregnant woman to have her husband with her at all times when she is in hospital after the birth. Currently all hospital wards have suspended visiting, except for a parent of a sick child, or a birth partner when a woman is in labour. I am irritated by this petition. I know my reaction is unfair and I am tired and my empathy levels are running low. I know how fortunate I was to have had four babies in ordinary times and be visited on the ward by my husband, my sisters, my mum.

But the unbearable truth is not that any human will be born or give birth alone, in the season of Covid 19. It is that many thousands will die alone, without the final comforting touch, voice or smell of their loved ones. Babies will be delivered into familiar hands. But the dying will say goodbye to their loved ones on an ipad, which will be held by a nurse who will try to be everything to that person, in their last moments on earth.

So if this is the season of anything meaningful at all, it is most surely the time when we stand in for each other. We afford dignity at birth and in death, bound not by familial ties but by our common humanity. And for us, it is the time when we learn to smile with our eyes.