“ 'A place for everything, and everything in its place' – or so the proverb exhorts us. But life does not always pay attention to our rules, the world is inclined to shift and change, according to its fancy, or its will. Turning habit on its head, offending the established order. We survey the chaos of the landscape and despair. How can this ever be rectified? And what are we to do with the detritus?”

Episode 6 dealt with several storylines: a garbage or trash collection strike takes place in Poplar with the resultant public health ramifications. Mrs. Bernie Midgely displays bigoted racial prejudice and impedes Nurse Joyce Highland in taking full care of her and “declines” to follow her evidence-based recommendations. This behavior harms Bernadette with a resulting blood clot in her leg (deep vein thrombosis or DVT), but her baseless threats can also greatly hurt Nurse Joyce Highland. 

Meanwhile, our Cubs are working on their Arrow badge and are to explore their local area to understand its history; however, with the trash surrounding the area, it is really too unsafe. Instead, the Cubs interview Sister Monica Joan and travel through time and place with her stories. And, the loss of sweet Nigel, the cat, helps Cyril realize he cannot be an island, and he does not want to travel his life path by himself. 

As a modern-day midwife, I could relate to the issues within Episode 6: the spread of disease based on manmade situations and witnessing racial prejudice and the negative impacts this can have on everyone. As well, how one’s perspective can differ, even when individuals all face a similar situation. 

In our episode, we saw this with the piling trash or feelings surrounding the balancing of rights between the dustmen and the residents. In current times, we are also witnessing differing views on individuals’ rights. We are seeing decreasing rights to protest at universities. We are witnessing limitations on the voice of reporters and journalists being silenced. We are living through a time where the healthcare decisions of one can impact the spread of disease to others. Unfortunately, we are aligning with similar issues as our Call the Midwife characters.

In our episode, we had literal and visual disorder. We had piles and piles of trash scattered everywhere. We could actually imagine and engage all of our senses with those living in Poplar. We could see the trash accumulating; we could hear the grumbling and complaints; and, we could almost smell the stench or odor. I know I cringed when I saw the rat in Trixie’s midwifery bike carrier and also as Dr. Turner ducked away from one rat hanging there as he went to visit his patient. 

We can have obstacles and varying perspectives. However, each person ultimately has to withstand, adjust, accommodate, overcome… OR… succumb to the negative outcomes. We saw varying styles in the episode in how to handle the rats. We saw Fred move the bicycles into Nonnatus House. We saw Sister Julienne suggesting traps to rid the environment of the rats. We saw Sister Monica Joan seeing this as a “transient inconvenience.” She stated that people were not displaying a backbone. 

Sister Monica Joan is wise and has lived through many major things, and she notes this as “a minor chapter in our history. It will pass. As all things do.” I love Sister Monica Joan’s resiliency!! 

In our episode, we have varying perspectives with either support for the right to strike – as opposed to the rights of the citizens for a healthy environment – and desire to trap and get rid of the vermin, as opposed to seeing them as one of God’s creatures. We had illness, with Reggie experiencing mild but uncomfortable gastrointestinal issues. But then we had more serious illness from the rats with Weil’s disease. This caused serious illness with Rosalind and, unfortunately, a death with Mr. Butler and even our sweet Nigel, the cat. 

The storyline of Weil’s disease reminded me of the recent pulmonary syndrome death of Betsy Arakawa, the wife of Gene Hackman. This past February, Betsy died of Hantavirus. Hantavirus is a rare respiratory disease caused by rodents. I did look to see what commonalities or differences we have with Weil’s disease and Hantavirus. Weil’s disease is also known as Leptospirosis. 

Both are caused from disease spreading from an animal to a human, which is called a zoonotic infection. Both of these viruses share that they are caused by a rodent. It can be difficult to distinguish between them, especially in the early stages. They have similar clinical presentations and an individual can also be co-infected with both pathogens, viruses and bacteria. With both diseases, we see flu-like symptoms, fever, and in some cases, severe complications, like renal or hepatic (liver) dysfunction. 

The other day in class, we were discussing differential diagnoses as we were doing a clinical simulation. So, I would have to tell my students that to distinguish between these two diseases we would need to work through our subjective information (patient history and review of their systems) with the objective data (clinical presentation with results from laboratory findings). 

It is hard, as there are many commonalities. But there are some discrete differences that can characterize each disease. A person with Weil’s disease can also have jaundice and even hemorrhage, while Hantavirus often has more pulmonary issues. Ultimately, we would need laboratory testing: blood tests, PCR testing, and cultures that would confirm or distinguish them for our final diagnosis.

In our episode, we saw that in the end, public health won out. They needed to call in military assistance to remove the trash!! It took illness and death to move them to this! 

Unfortunately, the remnants of prejudice are not as easily removed or swept away – I know this storyline will continue, so, I will save my comments regarding this topic for another blog. But I really had respect for Nurse Joyce Highland when she responded to Sister Julienne's inquiries by stating, “I could laugh that you have even asked me that. Or I could cry. But I can only do what I always do and try to respond with dignity.”

As she affirmed, she had experienced racism during her training, on the ward, in the district, and at the maternity home. “I survive it because it is not all there is. Just as my skin is not all there is of me.” 

Nurse Joyce Highland really displays resiliency. However, it is essential to remember that we need to take care not to crush the spirit. We need to make sure we protect and nourish every individual. We need to treasure every human life.

“Perhaps it is not what we do with our rubbish that matters but what we do with the things that we most treasure. The time for cherishing is short, the time for mourning often longer. Lessons bloom from the dirt and the flowers must be nurtured. A stem in careless hands can snap and petals can be crushed. But the seed and the shoot have a power all their own. Water them, shield them, respect them. Then love can render the fragile, indestructible.”