Farewell To The East End

CYNTHIA

I was cycling back to the convent after a morning’s work, weaving my way in and out of the lorries on the East India Dock Road, singing to myself as I pedalled the old Raleigh, which was as heavy as lead with two of its three gears not working, and perfecting my no-hands-steer-with-knees-and-bodyweight technique, when I saw Cynthia ahead of me. She was cycling more slowly than me, and her bike was wobbling about on the road. I called out, ‘Hi, there!’ as I drew level; but my high spirits quickly changed to concern. She was crying.

‘What’s up? Oh, Cynthia dear, what’s happened?’

She looked round, tears streaming down her face. A lorry screeched past, hooting noisily, its driver gesticulating obscenely.

‘Here, we had better pull into the kerb, or we’ll have an accident. Now what’s up? Tell me. I’ve never seen you like this before.’

Cynthia was the peace-maker amongst us, a wise and mature influence. To see her crying in the street was a real shock. I gave her my handkerchief because hers was wet.

‘The baby’s dead,’ she whispered.

‘What? It can’t be,’ I gasped incredulously.

I knew she had been out all night. She had come into breakfast tired but happy, telling us of the delivery of a baby boy – a normal delivery, a healthy baby, and a contented mother. She had left them at 6 a.m., everything satisfactory. We were required to make a return visit within four hours. I had left to make my morning visits at 8.30, and Cynthia had remained behind to clean and sterilise her equipment and write up her notes before returning to the newly delivered mother and baby at 10 a.m.

‘What happened?’ I asked when I had recovered from the shock.

‘I went back to the house as usual,’ Cynthia explained. ‘I never thought anything would have happened. The door was open, and I went in. Everyone was crying. They said the baby was dead. I couldn’t believe them. I went and saw the baby. It was quite dead and cold.’

‘But how? Why?’

‘I don’t know.’

She blew her nose and wiped her eyes. ‘I don’t know. I just don’t know,’ she whispered and started crying again.

‘Look here, we’d better get back, but don’t try riding that bike. You’ll only fall off. I’ll push it for you.’

We started walking along the pavement, with me pushing both bikes – a noble but futile gesture. Have you ever tried pushing two bikes along a pavement crowded with people and prams and children running around? Soon Cynthia’s tears were mixed with tears of laughter.

‘I’ll take mine, or you’ll do someone a nasty injury.’

We walked along without speaking for a while. I didn’t know whether to ask more questions or to keep silent, but she said: ‘They’ve taken him away.’

‘Who? The doctors?’

‘No. The police.’

‘Police? Why? What for?’

‘Post-mortem examination. The parents didn’t want them to, but the police insisted, saying it was the law with a sudden, unexplained death.’ Her voice faltered and she started crying again.

‘I don’t know if I did anything wrong. I’ve been going over and over it in my mind. I did everything we were taught to do. The baby cried soon after birth. I cleared the airways. I cut the cord aseptically. All his limbs moved independently. His spine was straight, his breathing was normal, and the sucking reflex was there. He was a perfect baby, I thought. I don’t know why he died, or if I did something that might have caused his death.’

She shuddered and could hardly walk straight. The front wheel of her bike hit a bus stop, and the handlebars twisted and poked into her chest, making her groan with pain. We straightened out her bike.

‘Of course you’ve done nothing wrong. You are the best of midwives. I just know it wasn’t your fault in any way.’

‘You can’t be sure,’ she whispered. ‘That’s why the police took him away.’

We continued for a while in silence. I did not like to intrude on Cynthia’s thoughts but felt compelled to ask, ‘What did you do?’

‘Well, I tried mouth-to-mouth resuscitation, but it was hopeless. The baby was quite cold and stiff.’

She was shaking, and her voice was barely audible above the noise of the street.

‘Let’s get off this main road into a quieter one,’ I said. ‘All this noise is getting on my nerves. Then you can tell me more.’

We pushed our bikes round a corner and continued in a more peaceful environment. Children were playing in the street, women were scrubbing their doorsteps or shaking mats. Several greeted us.

‘I went down the street to the phone box,’ Cynthia continued, ‘and rang Nonnatus House and spoke to Sister Julienne. She came straight away. It was wonderfully reassuring to see her. She christened the baby, even though he was dead, and prayed with the family and me, and then she went to inform the doctor and the police. I had to remain in the house with the baby’s body.’

She started crying again. I leaned over and squeezed her hand.

‘We didn’t have to wait long. The doctor came. He examined the little body and said he could see nothing to suggest the cause of death, but that a post mortem would be necessary before a death certificate could be issued. The family were terribly upset at this, saying they didn’t want to see their baby cut up, they just wanted him to have a quiet Christian burial. The doctor was ever so kind with them, but explained that a PM was unavoidable under the circumstances.’

We continued plodding along, circling around a group of little girls playing hop-scotch.

‘Two policemen arrived. They took notes and spoke with the doctor. Then they questioned me. It was awful. They weren’t nasty or bullying or anything like that ... it was just being questioned about a death, and seeing them write down everything I said that was so awful. I must have looked as white as a sheet, because the doctor was very kind and assured me that I was in no way at fault. I had been asked to tell them everything I knew, you see. They asked to see my records, and took my notes away with them. I think I had filled in everything correctly. I don’t know. It’s like a bad dream.’

She looked ill.

‘You need a good hot cup of tea,’ I said, ‘We’re nearly at the convent – good thing too. You look just about finished.’

‘It’s the shock, I suppose.’

‘I’ll say it is!’

‘I’m cold, too.’

‘Not surprising. You had no sleep last night?’

‘A couple of hours, then I had to go out.’

By now we had reached Nonnatus House. I took both the bikes to put them away. Cynthia said she had to report to Sister Julienne as soon as she got in.

In the bicycle shed Sister Bernadette was putting her bike away.

‘Ah, Nurse Lee. Just the person I wanted to speak to. Did I see you cycling with no hands down the East India Dock Road?’

Sister Bernadette was a midwife whom I both respected and admired, but she could be very sharp.

‘Me? Oh, er, well perhaps ...’

‘I am sure it was you. I can’t think of any other midwife who would cycle in that nonchalant fashion down the main road. And were you whistling by any chance?’

‘Whistling? Well, I’m not sure. I can’t quite remember, but I suppose I might have been.’

‘You certainly were. Now look here, Nurse Lee, you are not one of the local lads. You are a professional woman. They can do that sort of thing, but you can’t. It’s too casual, too lackadaisical. It gives the wrong impression. It simply won’t do.’

‘I’m sorry, Sister.’

‘Don’t do it again, Nurse.’

‘No, Sister. I won’t, Sister.’

But I did, and I’m sure she knew that I did!

Cynthia did not come in for lunch. She had been sent to bed with a couple of aspirins and some hot chocolate. Sister Julienne said grace and when we were seated told everyone what had happened.

‘Humph,’ grunted Sister Evangelina, ‘alive and healthy at six o’clock. Dead at ten. Sounds like smothering to me.’

‘Oh no, Sister. I am sure you are wrong. They are a nice family. They wanted the baby. They wouldn’t do a thing like that.’ Sister Julienne was shocked.

‘Can’t be sure. No one can. These secrets are well kept. There have been more unwanted babies smothered than I’ve had hot dinners. Desperation drives people to do it.’

‘But these people are not desperate,’ Sister Julienne replied. ‘I agree with you that desperation might lead a starving family to smother a newborn baby, but those days are past.’

Chummy, Trixie and I were wide-eyed with interest. We had heard nothing like this before, coming as we did from middle-class backgrounds. But Sister Evangelina had been born into the slums of Reading in the 1890s and had experienced more poverty and deprivation than we could ever dream of.

‘But wouldn’t they be caught?’ asked Chummy.

‘Probably not.’ Sister Evangelina glared at Chummy, and then at Trixie and me. ‘You young girls! Ignorant! Don’t know anything of the past! So many babies were born, and so many died, that the authorities would never have noticed a few smothered here or there – especially if a relative had assisted at the birth, and no one else. The family could just say the baby was still-born.’

‘But why?’ asked Trixie.

‘I’ve told you: desperation. Poverty, starvation, homelessness, that’s what drove people to do it. Read your history books!’

Sister Evangelina was a formidable lady. Her temper was irascible, and the fuse short. We dared not press her.

Aristocratic Sister Monica Joan, who was in her nineties and whose mind was not entirely reliable, had eaten very little. She picked at the mashed potato and onion gravy which Mrs B had lovingly prepared for her, pushed her plate aside and sat fingering her spoon, turning it this way and that as she held it between thumb and forefinger, with the other three fingers arched fan-like. She was watching the changing light in the bowl of the spoon and the reflections of those around her. She giggled.

‘Now you are upside down. Now the right way up, but your face is all fat ... hee, hee, hee! Now it’s thin. This is such fun. You should have a look.’

She appeared to be completely absorbed in the spoon and her own thoughts, and I doubted whether she had taken in a word of the previous conversation. How wrong one can be.

Sister Monica Joan had the instincts of an actress, and her timing was impeccable. She dropped the spoon onto the table with a clatter. Everyone jumped and looked at her. She was now the focus of attention, which she relished. She looked coolly around the table at each of us, and said unhurriedly: ‘I have seen several cases of smothered babies, or perhaps I should say, where I have strongly suspected smothering, but could not prove it.’

She looked around to judge the effect of her words.

‘We had a young maid at the convent – not this House, the one that was bombed out – she was a sweet girl from a respectable family. After a few months, it became clear that she was pregnant.

She was only a girl of fourteen. We were quite shocked, but kept her on, with her mother’s approval, until her time. Then we delivered her baby in their little house. One of our Sisters delivered it, and everything appeared to be satisfactory, if an illegitimate baby in a respectable family can be described as satisfactory. At any rate, mother and baby were alive and well when the Sister left them. A few hours later a note was brought to the convent saying that the baby had passed away. The Sister went to the house and found the baby dead, and the child-mother deeply asleep. She could not be roused. It looked like a sleep induced by laudanum. An inquest was held, but nothing was proved.’

Sister Monica Joan picked up the spoon again and turned it in the light, gazing intently at the changing shapes.

‘Everything looks so different from varying angles, doesn’t it? We see things one way and assume it is correct. But then, move the light just a fraction ...’, she turned the spoon slightly, ‘and you see it quite differently. Very often the death of a baby was seen as a blessing, not as a tragedy.’

‘Very true,’ grunted Sister Evangelina, ‘if a family already had half a dozen mouths to feed, and no food and no work, it would be a blessing.’

‘Poverty. Grinding, abject poverty with no end.’ Sister Monica Joan turned the spoon again, gazing at it. ‘We were the greatest empire the world had ever seen. We were the richest nation in the world. Yet turn the light just a little and you see destitution so terrible that men and women were driven to kill their own babies.’

‘Surely you exaggerate, Sister?’ said Sister Julienne in a shocked voice.

Sister Monica Joan turned her elegant head and raised an eyebrow. No one could have looked less like a champion of the poor!

‘I do not say it happened all the time, nor that every family was guilty. But it happened. You are too young to have seen the conditions in which working people lived. A thousand people crowded into a slum street of decaying buildings with no lavatories, no furniture, no heating, no blankets, no water except the rainwater that seeped through the rotten roofs and walls and basements. And above all, never enough to eat. In this I do not exaggerate. I have seen it. And not just one street, but hundreds of them. An endless warren of slums, housing hundreds of thousands of people. Read General Booth or Henry Mayhew, if you don’t believe me! Of course babies died all the time, and of course some were helped on their way by a desperate parent. What else would you expect?’

Trixie, Chummy and I could not speak. Her words and her appearance were so compelling that nothing further could be said. But Sister Julienne spoke.

‘Let us thank God that those days are past. Such poverty will never be seen again in this country, though it exists in many parts of the world, especially since the last war, and we must pray for those people.’

At that moment Mrs B came in with pudding, which she took over to Sister Julienne. Mrs B was Queen of the Kitchen – an excellent and valued cook.

‘I’ve made a nice junket ’ere for Sister Monica Joan. A strawberry one. I knows as ’ow she likes strawberry best.’

‘Junket! Ooh yummy. And strawberry too!’

In an instant Sister Monica Joan changed into a little girl at a birthday party, contemplating the feast with gleaming eyes. She said no more about the sinister disappearance of babies, but quietly I resolved to read General Booth and Mayhew on the subject.

Cynthia was rested, but subdued and sad, when she came down for tea at four o’clock. She carried out her evening visits as usual, and over the subsequent days she continued her duties. But we could all see that the baby’s death was weighing on her mind.

The post-mortem report was received a week later. The baby had died of atelectasis.

Atelectasis means a non-expansion of the lungs. It is not a disease or malfunctioning of the lungs. During foetal life the lungs are airless and collapsed (i.e. in a state of atelectasis). When the baby is born, with the first intake of breath, the lungs expand. However, small patches of atelectasis, or non-expansion could (and still can) remain for a few hours or even days, and these patches could go undetected. If the baby’s general condition was good there would be no cause to suspect a collapsed or unexpanded area of lung.

Cynthia’s baby was full-term and breathed vigorously at birth with perhaps only three-quarters of the lung capacity; he had a good colour and a good heartbeat and cried and kicked lustily, so there was no cause for alarm. However, a newborn baby is very delicate. As he lay still and sleeping, the effort to breathe with a reduced lung capacity may have been too much for him. Breaths would have become shallower and shallower until the lower lobes of the lungs were not expanding at all. They would then collapse, causing a larger area of atelectasis to develop. Shallow breaths drawn only into the upper lobes of the lungs cannot feed sufficient oxygen into the body to sustain life. The baby would simply have breathed more slowly and more feebly, until even the upper lobes collapsed, and the baby died.

Cynthia was completely exonerated by the post-mortem report. It confirmed that with the baby’s first breaths the greater part of the lungs had expanded but had subsequently collapsed during the four hours when the baby was alone with his mother. The question of why the mother did not notice anything unusual (for example, difficulty in breathing, change of skin colour from pink to blue to pallid white, with limpness of muscle tone) and raise the alarm was left unanswered.

No blame was attached to Cynthia, and no fault was found in her delivery or her immediate postnatal care. However, the whole experience had a deeply depressing effect on a sensitive young girl who kept asking herself, ‘Could I, should I have done something differently?’ and the trauma did not easily go away.