For the fourth season in a row, we are honored to have the faculty of the Vanderbilt School of Nursing back to guest blog for us each Monday morning about the previous night’s episode of Call the Midwife, airing Sundays on NPT and PBS Stations nationwide at 7 p.m. CDT through May 17. Check in every Monday morning for historical and contemporary context on the show along with some fun discussion. SPOILER ALERT: Be aware that some posts may contain spoilers.
By Michelle Collins
We saw the midwives treating the pregnant woman for diphtheria, which probably none of us has ever seen in our lifetime since diphtheria immunization is currently widely practiced. Diphtheria is a life threatening infection that begins with symptoms easily brushed off as an ordinary upper respiratory infection – low-grade fever and sore throat. The bacteria causing diphtheria reproduce in the throat and form a strong film which can actually cause the person’s airway to become obstructed. This film was historically dubbed the “strangling angel,” as literally, victims can choke to death.
Consider that not until the 1920s was adequate diphtheria vaccine coverage widely available. Prior to that time, there were as many as 100,000 to 200,000 reported diphtheria cases in the U.S. yearly. We cannot fathom the magnitude of 206,000 cases and 15,520 diphtheria-related deaths annually, most of those deaths among children, which was the actual state of the disease in 1921. (See Immunizations for Public Health.) Compare that to the present day, in which only one case of diphtheria (or fewer) is seen annually in the U.S.
Also in this episode, we saw a realistic example of the vulnerability we feel as healthcare providers. When Dr. Turner (played by Stephen McGann) missed the diagnosis of a very rare disease in the baby with multiple bone fractures (which turned out to be osteogenesis imperfecta, also known as “brittle bone disease”) it sent him into a downward spiral of self-doubt, and dealt a heavy blow to his confidence. Every midwife has had those moments where we wake in a panic in the middle of the night thinking, did I overlook something in that patient? Or, did I miss something in the course of that labor that I should have picked up earlier? Any midwife (or practitioner) who says this has never happened to them simply hasn’t been practicing long enough.
Most of the time we midwives would agree with people who tell us we have the best job. When all is going well, it is an awesome job (arguably a calling much more so than a job). There is nothing that compares to receiving a new life into one’s hands; it is a privilege to be sure. However, when things go wrong or there is a bad outcome, there is literally nothing more sad or tragic. Given that, we all just try to do our best every day, with every patient, despite overbooked schedules and little sleep, juggling work and family, often times while enrolled in school to further our education. Just as Dr. Turner realized, we are all human, and no one individual is perfect.
Was it reasonable that Dr. Turner surmised, from the baby’s symptoms and history, that the fractures were a result of child abuse? Absolutely, because 99.9 percent of the time that would have been a correct diagnosis. The reality is that even a slight error on our part could have catastrophic consequences. That, my friends, is just sometimes too great a truth for any midwife to dwell on.
Michelle Collins Ph.D., CNM, is an Associate Professor of Nursing, Director Nurse-Midwifery Program, at Vanderbilt University School of Nursing.