Nurse Jenny Lee: I need to care. I cannot ration it, or turn it into an efficiency.

"I cannot turn it into an efficiency."

Once again, "Call the Midwife"  focuses on an essential truth,   missed by all the American doctor/ nurse/medical shows about the rapidly evolving world of medicine. It is a truth about the tension between efficiency and affection.

  Nurse Lee has returned to nursing, after a time out to recover from the death of her boyfriend. Rather than return to the East End midwifery service which provides home care and home deliveries, she opts for something of a new start at a busy London maternity hospital, where the National Health Service has designed large wards to deliver maximally efficient care to large numbers of women. 

To accomplish maximal efficiency, the tasks related to labor and delivery are divided, much as one would do on an assembly line, and Nurse Lee finds herself providing pre labor care on a busy ward, but once the mother to be  actually goes into labor, Lee has to hand off her patient to the delivery suite people; the mother is literally wheeled out of the ward, from one point on the line,  down to the next. Lee finds this loss of connection to the patient wrenching, as do some of the patients,  who came in frightened but are calmed by Nurse Lee, but once having established a connection, they are separated and hauled off to the next team for delivery. The laboring women are thus treated like partially assembled automobiles on the assembly line: one worker rivets in the door, the next puts on the tires. 

When Lee volunteers to stay after her shift has ended, to follow a patient who has become particularly attached to Lee,  the Sister (Head Nurse) rebukes her decisively and orders her off the ward.  What? You want to attach the tires, too? You'll wreck everything. 

Of course, the same thing is happening now in American hospitals, where, owing to Libby Zion laws, residents are sent home at the stroke of end of shift, no matter where they are in the care of their patients. 

It is not easy to dramatize what this shift work, division of labor does to patient care, but  "Call the Midwife" was able to do this artfully and persuasively and in the end, Nurse Lee gives the Sister (head nurse) her notice,  and says she is going back to the humble practice in the East End. She says, "I respect enormously what you do here, but I need to care. I cannot  ration it or turn it into an efficiency. That will never be my way."  She simply needs to connect with the mother and child and see them through to the conclusion.

Her statement, the most powerful indictment of bean counter care ever to be launched across the public airways, is delivered without bombast or even much drama. It is a simple, honest statement of faith in the old time religion. The choice of words is deliberate, precise and effective. She does not say, "that is just not my way." She says, "That will never be my way."   A subtle, but distinctive difference. She is not simply making an observation about herself, but a statement about the way things will and ought to be into the future, because that is the right way and always will be as far as she is concerned. Most of the viewing audience probably missed it, but  doctors and nurses leaped to their feet, in front of their televisions,  and cheered. 

There, she said it. Finally, someone has said it. 

So, Nurse Lee gives up her much prettier uniform, and her more plush and prestigious surroundings and goes back to the East End, where the midwives dress in simple, unadorned blue frocks and burgundy  cardigans and she is welcomed into the warmth of her adoring friends and patients, and we can feel the satisfaction of human connection triumphing over glossy material  attractions.

They need to care. 

This is what American doctors and nurses are confronted with now every day: The money drives everyone toward a division of labor, breaks down the complex tasks once done by a single practitioner,  into a series of billable tasks,  done by technicians, swiping bar codes from medication carts in front of portable readers on the wards. 

  Making a car lovingly by hand, one at a time cannot compete with the cars churned out by an assembly line. But delivering health care is a service, a process between people and efficiency demands detachment, and can be taken only so far before some crucial bonds are broken. So a patient seen by a doctor who used to do the history, then the physical exam, then the sonogram, then draw the blood, write the prescription and give the final instructions, that patient is now seen by a succession of technicians and her contact with the doctor is limited to 10 minutes. She develops a relationship with no one,  but  the tasks get  done, by robots, more or less. 

The Phantom is reading Stephen Ambrose's "D-Day" in which he explores the differences between the Brits and their American allies,  which came into bold relief once Americans flooded into Britain prior to the invasion of Fortress Europe. The Brits thought the war might be won after all, using "American brawn and British brains." They sensed what the Phantom had sensed--the Brits are simply brighter than we are, at least in some ways. Certainly, their television can be. 

Nurse Midwives at home in the East End