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Tuesday, August 21, 2007
Loss of nerve
Edward Paul Brown was a premature baby whose birth and death took place within minutes of each other on February 23rd 2007 in a lavatory in Queen's Hospital, Romford.
Eighteen weeks into her pregnancy, his mother, Catherine Brown, was told that there was no amniotic fluid surrounding the baby in her womb. This meant that the baby's chances of survival were minimal and her own life was threatened. Catherine Brown took the "devastating" decision to abort. Even those (such as I) who generally oppose abortion, will see this as a hard case - and I hope that any comments do not get sidetracked onto that issue.
So. We have a woman in hospital waiting for the procedure that will abort her baby, a child she had wanted to bear and raise. Not a pleasant situation at any time, but what followed next was disconcerting to read about even for those who have grown weary of NHS "war stories".
I first saw this in the Times (Baby's birth and death in lavatory of hospital with no trained staff), but there is a considerably more detailed account in This Is London (Mother forced to give birth alone in toilet of 'flagship' NHS hospital) (A very similar account appeared in the Daily Mail.)
Both headlines understate the peculiarly modern horror of what happened. The reader gets a picture of nurses trying to help, but out of their depth because Queen's Hospital did not at that time have a proper maternity unit. That picture is wrong. The part of it that is wrong is the "trying to help." The nurses declined to help.
This Is London quotes Catherine Brown's mother, Sheila Keeling, who was present as her daughter went into labour:
"I was running around frantically trying to find gas and air for her and pleaded with nurses, who seemed very matter of fact, to assist," she said.(Emphasis addded.)
Not just could not help, would not. Would not even be present, as far as I can see. Modern nursing has moved on, you know, since the days when the role of the nurse was to hold your hand and wipe the sweat from your brow. They don't do that any more!
What caused these nurses to hang back from offering the ordinary, unskilled comfort that would once have been seen as the heart of their calling? I am tempted to simply blame it on the NHS. Certainly this case is something to set against all those stories we hear from those benighted lands where healthcare is not financed by taxation. Of course I do blame the NHS for the dreary catalogue of delays and mismanagement that Catherine Brown suffered before the birth; the wait for a scan, the further wait for pain relief, and the fact that she had to lie in a mixed sex ward and the fact that they nearly dumped Edward's dead body. But that is old hat. Things were no different a decade and a half ago when I was in labour in another hospital in Essex and the midwife was obliged to run out into the corridor and yell "Where's the fucking obstetrician?" And my would-be epidural man popped his head round the door and announced that he was ready to begin twenty minutes after the birth. I did not hold it against them. It was a difficult day, lots of births happening at the same time. At least they tried. In Queen's Hospital as Catherine Brown crouched over the support bar of a disabled person's lavatory to deliver her doomed child, they felt themselves unqualified to try. More than their jobs were worth.
No, this gutlessness is new, and although I do see it as yet another consequence of the command economy of the National Health Service, to add to the melancholy consequences we knew about already, I seek a more specific explanation as well. One major factor might well be fear of getting sued. Yet that, too, does not wholly explain it. The nurses concerned must have known that their chances of being held personally liable were tiny and they must also have known that the chances of their hospital getting sued for neglect of duty were significant. (None of the reports I have read in the press say whether this happened, although clearly some official inquisition took place and reached the verdict that press has been reporting over the last few days.)
The loss of nerve is not just seen in hospitals. One can see it in the other public services too.
Looking at the fire service, fireman Tam Brown nearly drowned saving a woman's life in the River Tay - and was rewarded by being threatened with disciplinary action by Tayside Fire and Rescue, on the grounds that he had "broken procedure" by entering the water. He was meant to use the correct ropes and poles and since his crew did not have the correct ropes and poles he was meant to watch her die. Possibly he was meant to put the down time to good use by filling in a safety report on the incident. As it happens he not only got away with his archaic belief that that was not what he had joined the fire service to do, but was belatedly praised for it by his superiors - but, make no mistake, as Squander Two says, that will be because of the publicity.
Looking at the police - Julia Pemberton was murdered along with her son by her estranged husband. She called the police as he rampaged with a shotgun through the house. You can read the transcript of her last 999 call here. "Officers are on the way," says the operator. That was moderately close to being true and the fact that the police could not even find the address of a woman whose house they had fitted with a panic button is not really relevant to this post. They got there in the end and saw the son, William, lying on the drive. At this point three unarmed officers vainly but creditably attempted to help him. Guess what? They were breaking procedure. In the words of Julia Drown MP,
However, the irony is that the officers who stand out as having done everything, and more, that the family could have expected from the police, were the ones who breached the police's policy.
The police did not actually go into the house for hours. Goodness, no. There might have been a violent criminal in there! Probably it made no difference. The victims were already dead. But for all the police knew Julia Pemberton could have been alive but desperately wounded and praying for help. Time was when the ordinary village policeman, unarmed as he was, would have gone in.
Let me say (before someone says it for me) that I do not claim that I would have the courage to go into a house where a killer might lie in wait, or that I would have jumped in the bitter, fast flowing waters of the Tay to save some stupid woman who wanted to top herself. But such were the traditions that were honoured in the police and fire services. In fact, when I talk about "gutlessness" and "loss of nerve" here I am not talking about individual physical courage. Fireman Tam Brown showed great courage. At least three of the policement in the Pemberton murders did as well and all of them showed more guts than I would. But institutional gutlessness surrounded them, was embarrassed by them, and will kill off their like eventually. Poisoned soil does not long give forth good fruit.
Going back to the Queen's hospital example, I do not have the personal qualities to be a good nurse, though I do think I could have bestirred myself to help in this case, when even standing around being useless because untrained would not have been useless and was clearly what the patient wanted. All the training nurses have these days appears to have trained the initiative and compassion right out.
I keep asking myself why anyone wants the new way?
Perhaps, in the case of those who will not act because unqualified in that speciality, it is a fear of finally having to be the real thing. When your whole life has been one long rehersal the raising of the curtain for the First Night is not always a welcome event. So Nurse Smith listens to the howling through the lavatory door rather than act wrongly and Constable Jones watches the stripy tape flutter around the perimeter of the silent house and waits for the Armed Response Team.
Perhaps, in the case of those who make these regulations, it is a peverted delicacy. Some are offended by the eruption of death or violence into their paper world, by the bloody evidence that not everything is covered by their rules. Below that delicacy, deeper and colder than mere personal malice, is a hatred of efficacy.
How do we get our nerve back?
(Cross posted in Samizdata. Comments are open there.)