Showing posts tagged with: 'bereavement'


The reality of maternal mortality: a father's perspective

Fri 10th Oct 2008 by Ben Palmer.

This is the text of the speech I gave to The Sixth National Conference on Current Issues in Midwifery organised by the British Journal of Midwifery yesterday. I have reproduced it here by popular request. I am not going to include the photographs of my family that I refer to, nor the medical charts, but the important information from these is in the text. The full version of the story is, of course, told in Friday's Child.

Good morning. My name is Ben Palmer, I am a father of two children, and a widower. I am also founding trustee and chairman of Jessica's Trust – a charity focused on raising awareness of childbed fever or puerperal sepsis, but more about that in a minute.

First, I'd like to introduce you to my family and give you a small and brief glimpse into our lives.

This is my wife, Jessica, and I just after we were married.

This is Jessica and our daughter Emily, just after she was born ... we didn't know she was a girl, so she's in her brothers hand me downs already.

It is one of only two photographs of the two of them together. Emily keeps it beside her bed wherever she stays.

Jessica died in June 2004 when Emily was just 6 days old, and three weeks after Harry's third birthday. She was 34.

This photograph is hanging in poster size on their bedroom wall, so that they will never forget her.

This is my family today.

Emily is a relatively carefree 4 year old still learning about who and what it is she has lost. Harry is a seven year old, unfairly burdened with the reality of maternal death. I'm less troubled than I have been, but a little greyer than I used to be.

This is a story that fills numerous files, but I'm going to condense it right down, hopefully retaining the salient information. Please remember that the small amount of medical knowledge I have now is 98% more than I had at the time.

I'm also going to illustrate the story with an early warning chart that I have filled in retrospectively from Jessica's notes. Unfortunately they were not being used at the time.

Emily was born at 6.26 on a Thursday evening after a complication free vaginal delivery. She was 9lb 13ozs. Jessica and I were ecstatic after the birth of our daughter - a sister for three year old Harry.

Jessica's temperature at delivery was normal, heartrate 78, BP 120/56.

After a sleepless night because of Emily's constant crying for milk, Jessica was shattered and wanted to go home, but her midwife was worried – Jessica was tachycardic.

At 9.40am Her BP had dropped to 80/40 and she was hot (although her temperature wasn't recorded anywhere that I can find it.) and her heart rate had increased to 90.

The SHO was bleeped just before 10am. Had the hospital been using this chart, these obs would have registered as a red score and should have made her a priority.

Through the day Jessica's heartrate rose to 100 - which would have registered as a yellow score - and with no sign of her, the SHO was bleeped again.

And again.

At 8pm the doctor at last visited Jessica without (Jessica told me) taking any fresh observations. Looking at the notes, it might appear that she re recorded the previous ones and then discharged her.

After supper that night, an hour or so later, Jessica was shivery and had blue lips.

I got her into bed and then took her temperature as she now looked flushed. It was 38.9C.

I could have called the hospital or, indeed, an ambulance, but two things occurred to us.

  1. that her previous symptoms - not that we fully understood them - had not been cause for concern, and
  2. that both of us had had high temperatures in the past with no ill effect.

I had no reason to think that Jessica was in any danger after a normal delivery. And anyway, as second time parents, we knew that the community midwife would be visiting the following day.

Jessica was tired and made it quite clear that she wanted to be left to sleep until the next feed.

Yes, the benefit of hindsight makes me uncomfortable about this. It was my missed opportunity.

Unfortunately, the midwife was too busy, with too many mothers, to visit the next day, but I told her on the telephone about Jessica's temperature and so she recommended paracetemol for the fever, should it return, and promised to visit the next day, Sunday.

Had the discharge form mentioned the problem or concerns in hospital, again with hindsight, I might have thought to mention it, but the 'Other problems' box was empty.

We were reassured and so got on with the business of looking after our young family.

Jessica came downstairs once over the weekend - in fact it was the only time she did in the three and a half days she was at home with us - and it wasn't for very long.

So, when the midwife visited on the Sunday, Jessica was in bed with Emily beside her.

She didn't have her thermometer with her, so just recorded that Jessica was feeling feverish.

She didn't know what Jessica's hot and red looking abdomen meant, so it was forgotten about. The midwife left Jessica after about 40 minutes and she carried on resting.

On Monday morning, Jessica was in a lot of pain in her lower back and so rang the GP's surgery. She was diagnosed as having sciatica and given Diclofenac. The medicine was great and made Jessica much more comfortable for the rest of the day, but the pills were obviously masking a worsening crisis.

By breakfast on Tuesday, Jessica was beside herself with pain and barely able to walk, and so I drove her around the corner to our GP. Jessica was seen immediately and referred back to the maternity ward by blue light ambulance.

On the way, her BP crashed and she was redirected to A&E. She was diagnosed with septicaemia and soon moved to Intensive care.

During the next twenty hours or so, I slept little, and shuttled between my home where my mother was looking after Harry and Emily, and Jessica's bedside.

She was given drugs for the infection and failing blood pressure in ever increasing strengths and dosages.

During the night she was put onto dialysis and a ventilator. I left her bedside at 6 in the morning to be at home when Harry woke up, but by eight in the morning, when I was called back to hospital after 40 minutes sleep, it was apparent that she was in very grave danger and deteriorating.

As a last ditch attempt to save her, Jessica was taken into theatre for a possible hysterectomy in the late morning. Almost immediately after the first incision, she went into cardiac arrest, and death was recorded just before midday.

Jessica died of multi organ failure caused by group A streptococcus.

I don't mean to judge or criticise - I just want to tell you what happened and why I'm here. Legally, the matter is closed after admissions of liability, but I hope there is something that everyone can learn from Jessica's case; parent, midwife and doctor.

I'd hate her death and our loss to be a wasted opportunity.

You don't need me to tell you:

  • that puerperal sepsis is no longer a disease of dirty practitioners like in Semmelweiss' day when it was being spread from mother to mother in the wards;
  • or to tell you that it is a community bacterium that many of us live with harmlessly - until it is given the opportunity to invade a body as in the case of a postpartum woman,
  • or that it is still the cause of 14% of maternal deaths in this country.

In the grand scheme of things, 18 deaths between 2003 & 2005 may be a small statistic, but the human impact is not.

What I do want to tell you is what happens when you wake up as a single parent and a widower, with small and confused children.

When I got home, broken hearted and in shock, I had to go on and on breaking others' hearts. Jessica's parents, my parents, our friends and family and my son Harry's.

When I told him that the doctor's had tried really hard to mend mummy's sore tummy, but that she was too sick and now she was in heaven with God and the angels where her tummy couldn't hurt any more, he just looked at me.

He didn't say a word. He was three - how could he understand what I was also struggling with?

Thanks to my mother and sister, and subsequently a nanny, our day to day life carried on during the first few weeks: meals were cooked and our routine was followed, but we were crumbling inside.

Harry's fear and confusion usually manifested itself at bedtime. He wouldn't settle, would often wet the bed, and frequently woke me in the night to climb in to bed beside me, but it was the shouting, the screaming, that was most upsetting,

"I DON'T LIKE MUMMY ANYMORE" he yelled at me once after an extended tantrum. He was angry with her for deserting us. Another time, he thought that maybe she and I had had a fight and was now living somewhere else.

How could she not want to see him or live with him anymore?

I lost count of the number of times we'd go through this sequence, and I quickly ran out of answers. In the end he - and sometimes I - would fall asleep on his bed, him in my arms.

Every time I took him to a party or to a friends house there would be trouble at night. He couldn't express it to start with, but he was angry that other children had a mum; what had he done wrong that meant he couldn't.

My own reaction over time was not much better. Consumed by anger, isolation and despair, I sunk into depression. I was eventually diagnosed in 2006 as having agoraphobia, anhedonia, dysthymia, depression and an alcohol dependence. I was drinking, on average, two bottles of wine a night - over 120 units of alcohol a week.

My work - I was self employed - was too much for me, and my clients politely drifted away one by one. I just couldn't stay focused. I got to the point where I didn't care about anything, myself included, other than Harry and Emily.

After being diagnosed, I was lucky enough to have counselling and a long course of cognitive behaviour therapy, and I have now stopped awfulising.

Eventually, life does start to get easier every day, but we'll never be 'better' - bereavement isn't an illness and it never goes away, you just have to learn to live with it.

Emily has never kissed her Mum, she and Harry will never have their mother there on red letter days. On Emily's first day at school last month, in her new dress, she looked at me with a sadness and simply said, "I wish my mummy could see me today."

What will she say if she graduates, or gets married?

My point is that death never goes away once it has struck, but what I want to underline, through Jessica's Trust, is the vital importance of regular and continued observations, fast recognition of symptoms and of action. By the time sepsis is clinically obvious, it may already be too late.

That was where the mistake was made in Jessica's case – too many people passed off the increasing symptoms as anything but dangerous, and Jessica and I were reassured into accepting symptoms that now make me shudder when I think of them.

My focus is to raise awareness of childbed fever - I want all of us, midwife and parent together, to understand it and to talk about it. The last thing I want to do is to invoke terror, but childbed fever should still be feared as it once was. That way another mother's life may well be saved, or she may just be saved from a long recovery from organ damage or a hysterectomy.

I want to see early warning charts being used routinely, and they should go home as well, for the community midwife.

I'd like to see more midwives, so that no one is too busy again, and I'd like to see a maternity service that is as valued with funding as it is needed by us as parents.

I hope that you will remember my wife, our motherless children and all the others like them.

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Hand in hand

Thu 9th Oct 2008 by Ben Palmer.

I deserted the children last night, leaving them in the capable hands of a family friend, and drove to Birmingham. It was a wrench: I'm not used to being away from Harry and Emily, and I didn't want to go. They didn't hugely want me to either. But go I did.

The Sixth National Conference on Current Issues in Midwifery organised by the British Journal of Midwifery asked me ages ago to talk about 'The reality of maternal mortality: a father's perspective'.

I'd been dreading delivering the short speech - how would they react? Would I falter, would my mouth dry up?

When I started I was nervous, and midway through I started to think I was losing them - there was rustling and shifting in seats. That made me really nervous.

Then I realised - it was tears and tissues. Jessica was touching them, Jessica was making a difference.

Afterwards, there were thanks, invitations to do it again elsewhere, write for the Journal, and so many hugs. What had I been worried about?

I've come away feeling like I've made a roomful of friends. Would I do it again? Yes, most certainly. For as long as I can reach someone who hasn't heard Jessica's story. For as long as Jessica can make a difference.

For all the women like her.

Update
Following a few requests and my off-blog correspondence with dovegreyreader, the text of the speech is reproduced here:
The reality of maternal mortality: a father’s perspective

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Why, Daddy?

Sun 16th Mar 2008 by Ben Palmer.

We just had a lovely weekend away, and drove back to London, in heavy traffic, in time for tea. The trouble was, Emily and Harry were so worn out from all the fun that they slept most of the way back.

Roll on to bedtime, and Harry can't sleep. An hour of requests for a cup of milk, a footstep here etc etc, and suddenly it became a little sob from the top of the stairs, so I went up.

There he was, sitting on the step with his two photographs of Jessica laid neatly side by side; the ones that travel with him, and always sit beside his bed.

'I just want to talk about Mummy.'

'OK darling, of course we can. What would you like to talk about?'

'Why did Mummy die? What is an infection anyway? Why do people die too early? How did the doctors know she was dead?'

I tried to field the questions as best I could, in suitable language, without causing extra alarm, worry or distress, but still they came.

'What medicine did they give Mummy? How did she actually die? What other question would be a good one to ask, Daddy?'

I can't lie to Harry about what happened, he has a right to know. But not at six years old, surely? I can't even tell him that all of the answers lie in four lever arch files, each three inches or so thick, full of medical notes, charts, statements, legal and medical analysis and argument - he'll want to read it, and then he'll get angry when I don't let him.

All I can do is promise him that the doctors did everything they could to save his Mummy, after she was admitted to A&E and once in Intensive Care. This reassures him, even if his curiousity isn't satisfied.

One day he's going to ask about before she went to hospital, and he's going to be so angry.

'There's nothing we can do to bring Mummy back, Harry, but that doesn't mean we have to like it.'

'What's Jessica's trust, Daddy?'

'It's Daddy's work - trying to stop other Mummy's dying like yours did.'

'What is child fever, anyway?'

'Childbed Fever? It's what Mummy died of. It's an infection that can kill you after you have a baby.'

'Why Daddy? Why did God want Mummy to die? He controls everything, so he shouldn't have let her die.'

I wish I knew all the answers, like Harry expects me to.

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What rubbish

Fri 15th Feb 2008 by Ben Palmer.

For as long as I can remember now, my work place at home has been the end of the kitchen table rather than my desk in the upstairs study. Working with my computer at the table has had its advantages - I am either in the same or the next door room to Harry and Emily when they play.

The trouble is, my piles of paper have grown, my office paraphenalia has increased, and the fight for space with craft materials, pens, half assembled wooden models and homework has increasingly been going the children's way. This morning I decided that it was time to again venture into the study I shared with Jessica.

Over the last few years it has been filled with christmas decorations, unused furniture and pictures, boxes filled with Jessica's clothes and anything else that didn't have somewhere to go. All of this I transferred into the spare bedroom today and I can see the floor again. What I needed to do next was to sort through the piles and piles of paper (before I move the piles up from the kitchen) so I grabbed a roll of bin bags and set to.

Incredibly I managed to fill seven recycling bags and two bin liners before the children's bedtime. I can now see myself going back in there to work, although now it's evening I'm back at the kitchen table.

A great deal of what I have recycled is Jessica's carefully filed paperwork. I had to stop several times and think, 'do I really want to be throwing this out?' No is the honest answer, but it is finally time. The memories of her are not in files or desk drawers, so their contents must go, but the clothes will stay for the time being. After all, one day Emily may want to wear some of them, even if she does have to wait for the fashion to come full circle again.

There was just one hand written scrap of paper I found that I wanted to share. I had torn it off the bottom of a letter sent to me a few months after Jessica died, and pinned it onto the notice board:

"A man is truly blessed when he has angelic children, because what ever happens during the day; when he comes home at night he is in heaven."

It still evokes mixed emotions, but I like it nevertheless.

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Intervention

Tue 29th Jan 2008 by Ben Palmer.

For the last two weeks we've been without our nanny, who's on leave. In the past, being without help for this amount of time would have filled me with fear, dread and at times depression.

For the first time since Jessica died I feel I am coping. Maybe it's because both children are at school/nursery during the weekday, but I don't think that's the extent. Possibly I've graduated as a Mum (albeit with a very basic level of qualification) or possibly it's because I also feel I'm able to help do something about the terrible condition that killed our wife and mother. Something, anything that prevents another's death is good.

Children's bedtime tonight was prompt and relatively struggle free, but Emily interrupted our bedtime rituals with, 'Daddy, I really miss Carly [our nanny] and Mummy.'

"We'll see Carly again soon, darling, and ..."

"But I still miss Mummy, Daddy."

"... we know we can't see Mummy, but we can look at her photograph, because she's safe in Heaven now. Mummy doesn't want you to be sad, Emily."

"Oww. But I reeeally miss my Mummy. I want to see her now, Daddy."

Even when they're without tears, these conversations leave me in no doubt as to why I want to start the ball of change rolling.

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Friday's Child is nearly ready

Wed 23rd Jan 2008 by Ben Palmer.

Thanks to Virgin Books and my hard-working editor, Friday's Child is almost finished. It'll be ready to print in a few weeks, in time for the June launch. It's got an updated cover as well, and for the first time I've seen the full book jacket - now I can imagine it on the bookshelves. I hope the reviewers are kind, though - it's my life, my inner thoughts and feelings. I also hope that it changes people's understanding of this cruel, painful killer.

From the jacket:

fridays_child_final_cover.jpg'In the summer of 2004, Ben Palmer was overjoyed when his wife Jessica gave birth to a beautiful baby girl. Emily was their first daughter and a little sister for their three-year-old son Harry. They had everything they had ever wanted.

Six days later, Jessica died of childbed fever, an archaic illness that causes blood poisoning, a condition that can be easily detected and prevented.

This is Ben’s raw, moving account of dealing with his grief while raising two small children as a single parent, and of how he successfully sued the NHS for negligence. As he struggles to comprehend his loss and to care for their two young children, he is overwhelmed by shock, anger, despair and guilt, before finally finding hope in the future, thanks to the love and support of his friends and family.

A story of living with a cruel and needless loss, this is also a story of two people who loved each other for richer, for poorer; in sickness and in health; till death tragically parted them.'

Friday's Child is now available to order from Amazon

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Wish upon a star

Sun 6th Jan 2008 by Ben Palmer.

Amongst other Christmas goodies, I gave Harry and Emily a very special present. It wasn't immediately the most exciting, nor the biggest, but it has had a big effect, and one which I hope will last them for the rest of their lives.

I gave them a 'Name A Star' gift box, with a registration form for the star at RA:0h30m33s, DEC:3°13'29" which, after great discussion, is now called Jessica Palmer's Star, or Mummy's Star to us, but that could be confusing because, "another Mummy might have a star, Daddy".

The idea stemmed from the great work that Harry has been doing with his Skyscape of Memories at the Winston's Wish website (which I commend to anyone with children who have lost a loved one of any age or generation) and even if the star is not visible to the naked eye, it will forever be close to our hearts.

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Angels

Mon 10th Dec 2007 by Ben Palmer.

Harry and I have just been to watch Emily's nursery nativity play. After the wise men had visited Joseph, Mary and baby Jesus in the stable and the Innkeeper had given up all hope of getting back to sleep, Emily arrived on stage as one of the angels.

She walked past us looking beautiful and so pleased to see us; trying to balance some serious acting and a big grin. When she stood on the walls of the stable she was quite definitely the best angel on the end of the line to the far right.

Nursery was collecting for Winston's Wish 'Wish Upon A Star' campaign afterwards. When I'd added a contribution, Harry wrote on a star. "I miss you Mummy love from Harry" and "I miss you Mummy love from Emily" before we stuck it onto a skyscape poster on the door. They were both really pleased, but in the car afterwards Emily burst into tears.

Silly Daddy thought she was saying, "I want my muzzy," when anybody could tell it was Mummy that she wanted. During the rest of the conversation, we decided to head over to the Winston's Wish website after tea, and create a star. Then we'll tell Mummy all about the play and how good Emily was.

"Cos, Daddy, Mummy's with the angels, so she'll know," Emily told me seriously, still with a tear on her cheek.

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Mums all around

Thu 22nd Nov 2007 by Ben Palmer.

I went out to dinner with the Mums from Harry's class again last night. It was a good turn out, a newly renovated pub with good food and a steady flow of wine and conversation.

At one point talk turned to Harry and how he has coped with not having a Mummy, and one of the Mums told me about a telly program, The Mummy Diaries in which Julie Stokes, the founder of Winston's Wish, helps young families cope with their mothers' terminal cancers.

Purely by chance, because I wasn't looking for it, I flicked over to it tonight just as the last of the three programmes in the series was starting. It was a gentle and beautiful programme about some very brave people. In their planning and understanding of the possible death of Mummy I could see so much of our family since Jessica's death - the same fears and worries were there.

I am humbled by some of the bravery I have seen. Children are stronger, more resilient and wiser than we adults may always credit and I am proud to be made aware of how well Harry and Emily measure up in those respects.

Next time we get together as a class, we're going to try and get the Dads to come along as well.

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Hair today

Sat 6th Oct 2007 by Ben Palmer.

I've neglected the blogosphere a bit lately - I've just had too much to do, but now it's a quiet Saturday and the supermarket has been suitably raided for the week, calm is (temporarily) restored to the Palmer house.

When I watch Harry on the sitting room floor, painstakingly drawing individual leaves on a tree, I am proud. When I watch Emily putting together an underwater scene jigsaw, with the six hair clips, two bunches, twelve hair bands, necklace and two bracelets that she made me put on her this morning, I am proud.

I couldn't wish two more beautiful, loving and kind children on anybody.

But I would do anything I could to stop the fate that has fallen on them from hitting another child.

To say "Goodbye, see you later" to your mother and go to nursery one morning and never see her again, to only be held by your mother for the first five days of your life is wrong. It is also unnecessary.

I hope that by speaking up I am making a small difference, but I won't rest until this country (at least) is free of this Third World disease of the Middle Ages. I loved my wife too much and I love her memory and our children too much.

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What is childbed fever?

Childbed fever is an infection of the womb in new mothers which can lead to septicaemia. If left untreated infection will cause organ failure and death - even in young, fit mothers.
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What are the symptoms? »
Childbed fever: the facts »

What's the aim?

We would like every parent and every midwife and doctor to know that childbed fever is still a very real threat to a mother's life.
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Can I help? »

Who is Jessica?

Jessica Palmer was a Mum. She died in June 2004, at 34 years old, of childbed fever caused by Group A streptococcus.
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This website contains general information about childbed fever. The information is not complete or comprehensive. You should not rely on the information on this website as an alternative to medical advice from your doctor or healthcare provider. If you have any specific questions about childbed fever (or any other medical condition) you should consult your doctor or other healthcare provider; and if you think you may be suffering from childbed fever (or any other medical condition) you should seek immediately medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.
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