“The dawns were paler and the mornings cool; yet we had few thoughts of autumn or harvest — for we saw the fruits of women’s labor every day. The wheel of our year turned slowly … work was its constant driving force — as present yet as changeable as the weather. But time passed in Poplar as it did everywhere holding mysteries and secrets in its net.”

Season 3 Episode 6 finds Trixie accepting a date to go see cricket with Tom, the local curate. However, the plans get altered due to a canceled school zoo outing and she finds their time together a disappointment. Shelagh decides to talk to Dr. Turner about adopting a baby. Timothy befriends a young classmate and Shelagh learns that he has been adopted.

Sister Monica Joan takes offense when she thinks that Fred is insinuating that her cartography of the heavens (mapmaking globe) is out of date but it is her own projection of fears about the "new" scientific evidence. She gives in to her temptation and looks at a magazine with its modern scientific depiction of the world. Later she states — more for her own sake that the mystery of the planets and stars are not fragile things — and that we have to realize we have nothing at all to fear from science.

It is the story line of Patsy that intrigued me. Patsy upset some patients and Sister Evangelina with her blunt communication style and is moved from the midwifery rotation and into the district rota. She blurts out to a robust child, “What a whopper — easy to see who you take after,” and she briskly announces that the mothers need to keep their children under control, and then she encourages them to make their way out after your prenatal visits!!

Patsy eventually shares with Trixie that she lived a life of privilege in Singapore until she was nine years old. Then her family were captured, imprisoned and tortured. She saw her mother and sister die of disease and malnourishment. She said she was sorry if people found her lacking compassion. When Trixie explained that patients need to see that she cared, Patsy retorts, “In the hell I grew up in — what was important was what we did — not some great show of sentiment and emotion.”

It is essentially her past — her challenging and tragic past that helped her give context to the puzzling patient scenario. His unusual symptoms may have gone unnoticed if she had not revisited her own pain to help find a diagnosis for this gentleman whom had been a prisoner of war — 16 years prior. It took that long for this tropical disease to surface and for Patsy — it had been many years of thoughts and feelings which may have been repressed and dormant.

As a Modern Day Midwife it made me think of the value of reflection in our clinical and professional development — not only as a practitioner but also as a member of a team. Reflective practice is about learning, professional growth and change. The process should increase your self-awareness and allow you to be more effective in a therapeutic manner. It lets us explore our strengths, limitations and our vulnerabilities. One method I have found really helpful throughout my career has been journaling. I have tried to explore what has happened within a case along with my thoughts and feelings. I try to reflect on what worked and what did not work and what changes I might make in the future.

Reflective practice facilitates the development of interpersonal skills, self-awareness and the ability to influence others towards positive change. These are key skills for nurses and midwives. Reflection helps us to foster an understanding of what occurred and how one’s own approach, personality and personal history contributed to the way situations arose and how they were dealt with (Oelofsen, 2012; Somerville and Keeling, 2004).

There is an excellent text titled "Reflective Practice: A Guide for Nurses and Midwives" (Taylor, 2006). There are helpful, practical perspectives about the emotional processes surrounding reflective practice. The author writes about the need to cultivate an internal silence which enables one to process thoughts more clearly and thoughtfully. She discusses drawing on personal experiences and memories, asking difficult questions, and thinking from a broader perspective such as how social or political factors make an impact on a situation. The author encourages us to be open to answers but also reminds us that there can often be partial or incomplete answers. She reminds us that “some questions may remain a puzzle.” She encourages us to look at many different factors and sources that can increase our self-awareness and she challenges us to be open and engaged.

I loved when the patient helps Patsy by stating: “Don’t let it eat you up for the rest of your life. Remember what I said — next time there is a storm you need to leave open both doors. Don’t let your misfortunes find a home.”

“History needn’t be a trap we can escape its web and shake off its weight of pain. We CAN change our minds and open up our hearts. We CAN let forgiveness speak and allow it to be heard, let friendship flourish and let love in so it might feed and sustain us all our days.”

REFERENCES
Oelofsen N (2012) Developing Reflective Practice: A Guide for Health and Social Care Students and Practitioners. Banbury: Lantern Publishing.

Somerville M, Keeling J (2004) A practical approach to promote reflective practice within nursing. Nursing Times; 100: 12, 42.

Taylor B (2006) Reflective Practice: A Guide for Nurses and Midwives. Maidenhead: Open University Press.

Katie Moriarty (CNM, PhD, CAFCI) is a Clinical Assistant Professor and Associate Director of the Nurse Midwifery education program at the University of Michigan. She has been a nurse-midwife since 1992. Her undergraduate degree is from the University of Windsor, and her Master’s and PhD degrees are from the University of Illinois at Chicago.
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