By Michelle Collins
Vanderbilt University School of Nursing
Call the Midwife is back for a seventh season and so are the faculty of the Vanderbilt University School of Nursing with a weekly guest blog. Watch the show Sundays at 7 p.m. through May 6, then read our blog each Monday morning for historical and contemporary context about the previous night’s episode. SPOILER ALERT: Some posts may contain spoilers.
Heed the above spoiler alert before reading further – and if you have not watched last night’s episode, be sure to have tissues handy when you do.
In the previous episode of Call the Midwife, beloved midwife Barbara (Charlotte Ritchie) became ill with what seemed like a run-of-the-mill upper respiratory infection. In Sunday’s episode, we learned that it had progressed to widespread meningococcal septicemia (infection). While at one point it looked as though she would rebound, Barbara eventually succumbed to her illness leaving Tom (played by Jack Ashton) a distraught widower.
What struck me about the episode was the display of devout service by midwife Phyllis (Linda Bassett). We watched Phyllis tend to Tom’s physical and emotional needs during Barbara’s illness and we saw her rally the other midwives to cover Barbara’s patients so their care would continue without a hiccough. Lastly, we saw Phyllis attend to Barbara’s needs by organizing the visitors with all the orderliness of a drill sergeant. In the quiet moments, we watched Phyllis sit and listen to Barbara’s realization that things were not improving (once she began to lose feeling in her hand). Phyllis didn’t try to placate or offer false hope; she was just there for Barbara.
In what was maybe her greatest act of friendship, Phyllis took on the heartbreaking task of sitting with Tom in Barbara’s final moments. Phyllis was as adept at “midwifing” Barbara out of this world as she had been at midwifing so many souls in. Phyllis’ last act of caring is escorting Tom back to Nonnatus House to deliver him into the loving embrace of friends after Barbara’s passing. Once Tom is safely surrounded by others capable of caring for him, we see Phyllis relinquish her responsibility and slip out onto the porch where she breaks down weeping. I found this to be one of the most compelling moments of the episode.
We midwives spend the majority of our careers caring for others. We walk with our patients through many wonderful moments, as well as many that are bleak and horridly painful. Thus, midwives (and other healthcare professionals) may reach a point when we have spent all that is in our emotional purse, so to speak. This can lead to compassion fatigue, a form of burnout that can develop when caring for others. Manifestations of this phenomenon include sadness, an inability to concentrate, feeling exhausted despite adequate rest, and loss of joy in activities that formerly brought pleasure. Most concerning is that this can lead to general apathy, wherein the provider just doesn’t have the capacity to care any longer. Losing the ability to care is obviously devastating for someone who has entered a caring profession.
Caregivers caring for themselves is imperative; just knowing that compassion fatigue can occur is the first step. Strategies like eating well, getting enough sleep, exercising regularly – all of these activities that keep us physically healthy – can also help to prevent burnout. Recognizing the signs in ourselves, and perhaps in those with whom we work, is also crucial. It takes time and acceptance of help (including that from an experienced therapist) to refill one’s emotional purse, and caregivers can rebound from compassion fatigue. The most important thing to remember is that one’s capacity to care and empathize does not come with a guarantee of perpetuity.
Michelle Collins Ph.D., CNM, FACNM, FAAN is a Professor of Nursing and Director of the Nurse-Midwifery Program, at Vanderbilt University School of Nursing.