by Jane Grant
Maitland jumped up and pushed past me to the door. She had not even replied to my ‘Good morning, Sister’, and so far had treated me as if I were an additional annoyance.
‘How’s the pig going?’ she called sharply to a passing porter.
I saw the expression on that bright-eyed individual’s face. He was looking as if he thought Maitland a pain in the neck.
‘Gloves on second vacuum, Sister,’ he replied cheerfully. ‘I’ll get the linen through - end of first case wiv any luck.’
‘It’s not a matter of luck, Watkins,’ said Maitland sternly. ‘The time factor is the only element involved. The gloves will only take another twenty minutes, then get that linen in as soon as you can. I particularly want the hip sheets sterilized.’
Fred Watkins raised his eyebrows. ‘Yeah, Sister. You usually do on Thursdays,’ he said with as much sarcasm as possible without being downright rude.
Maitland scowled, and returning to the desk picked up the list again. ‘Well, if Mr Camden is doing this fracture he’ll want the self-retaining retractor as well as the two doyens. I only hope Mr Morley can make do with one.’
She pushed past me again with a short sigh of annoyance, and went to the instrument room.
I waited nearly a minute to assert my independence, then filled with an anger that was partly a reflection of her annoyance, and partly caused by the heavy affront to my pride, I followed her.
She was inspecting the instruments, which were glistening in orderly formation on their pins, arranged neatly close together on their stainless steel trays. Notes littered the smaller case trays. ‘Please add Spencer Wells.’ ‘Two Lane’s. Set of chisels.’ ‘Mallet.’ Few operating theatres have enough instruments to make up complete sets for the entire list, so the first two cases in both theatres would have all the instruments, and later sets would be added to as the first cases were completed. This was one of the causes of confusion in theatres; the trolleys removed the dirty instruments, which were then cleaned and re-sterilized for further cases. In a well-run theatre this procedure would be carried out without a hitch. In a badly organized theatre fuming surgeons would wait impatiently glaring at the scrubbed nurse, while a frantic runner rummaged through bowls of dirty instruments seeking the one precious tool required. (It helped if the nurse knew the name of the instrument in question, but it quite often happened that students fresh from the ward were incapable of remembering what any instrument was called or what it was for.)
‘Have you ever used a Desoutter?’ Maitland was looking at me with a curiously malicious glint in her eye as she patted the taped tin where the drill for boring holes into human bones lay. It was snug in a blanket of formalin tablets, its delicate mechanism not being able to stand being boiled along with the more mundane instruments.
I was checking a tray of instruments which referred to No. 6 case on the List. ‘Mr Marvin, Ward C1. Removal of L. Hallux.’ I paused a moment, and tried to reply with a careless air. ‘Once, ages ago.’ I added, to make the matter clear in a remote contingency of her letting me scrub for a case, ‘I haven’t done much orthopaedic work at all.’
‘That’s great,’ she said with venom. ‘Typical of the office, I must say. They send me a Sister who knows nothing of orthopaedics in an Orthopaedic Theatre.’
I swallowed my resentment. ‘I’m very willing to learn, Sister,’ I said quietly.
She then dropped a bombshell. ‘Well, you’ll have to take this hip anyway. I’ve too much to do in the office this morning.’ She saw my amazement, and two spots of colour appeared in her cheeks. In a louder voice, she added; ‘You’ll just have to do the best you can.’
My anger and alarm combined to render me speechless. I tried very hard to keep calm, but the thought of something going wrong in this delicate operation made the blood come to my cheeks and my heart start racing. At last I managed to speak; in spite of all my efforts my voice shook a little.
‘Sister, don’t you think that’s taking rather a risk? I’ve never scrubbed for this man before, and I’ve never seen a pinning.’
‘As you just remarked, Sister,’ she said with a wintry smile, ‘you will have to learn.’
She doesn’t care, I thought. She is a responsible Sister with lives under her care; she doesn’t care about the patient and she doesn’t care about me. She just wants something to go wrong to justify herself in some way.
I hardly recognized my own voice as I burst out; ‘So I’ve got to learn, and what better way than to learn on some wretched patient, flung into a major orthopaedic case with a surgeon I’ve never seen before, whose techniques I haven’t a clue about ‒’
I was interrupted by her icy voice; ‘Sister, I’m sorry, but you will have to take this case. Please say no more about it.’
She swept out into the corridor, and tight-lipped I followed her. The hubbub of a big day in the theatre was already beginning. A cluster of nurses stood gaping at the work sheet for the day.
‘Oh blast ‒ the sluice again.’
‘Gosh! I’m scrubbing for the Bunions.’
‘Blinking plasters ‒ I’ll go nuts if I ever see another.’
The chatter was turned off as by a tap as Maitland entered. She looked pointedly at the clock as a rather fat little nurse came scurrying out of the nurses’ room tying her mask on over her enveloping theatre cap. I thought for a moment she would get away with it, but Maitland waited till she got to the duty board and then spoke. ‘Mills!’ she snapped, ‘go and put your cap on properly. I can see some hair.’
‘Yes, Sister.’ The girl turned to flee.
‘And Mills ‒ you’re late!’
The theatre was washed down; the table prepared with all the fitments for supporting an unconscious body put in place. The lids of the already sterilized sutures and needles were removed from their glass cases, ready for the sterilized forceps to pick out the one required. The scrub-ups were ready; a sterilized towel was laid over the trolleys, sterile gowns, gloves, glove powder, laid neatly on tops covered by more sterile towels.
There was a muted curse from the instrument room. ‘That was sterile! Till you knocked it with your fat backside!’
‘Oh well ‒ the mac will do.’
Mac, trolley top, kidney dishes, water, instruments, another enveloping towel all ready for the scrubbed nurse to add her swabs which had been carefully checked and counted. The towels to wrap round the offending area of the body, the needles and catgut required to sew the wound the surgeon is about to inflict with the scalpel and scissors …
I checked it all and checked it again. I was hoping to see Mr Camden before the operation, to explain that this was a new procedure to me. I had no idea what he wanted or when he wanted it.
But he came in late, hurling last minute instructions at a panting team of students and housemen, and was obviously in a preoccupied mood; he changed with indecent haste, so I hurriedly scrubbed lest I be caught unprepared. Wildly guessing at the number of blade he would use in his scalpel, the type of needle and catgut he would need, I hastily prepared my trolley.
Meanwhile in Ward B2 the hours had passed. Preparation and injection, and then trolley wheels rolled along the corridor. The theatre porter in white overall and jaunty cap, chatted to Nurse and discussed how to take her. ‘Put your arm round my neck, love.’
The agony of movement, the cramping on the trolley with the heavy sandbag pressing! ‘Please can you move the sandbag.’
‘Sorry, love, we’ve got to keep the leg straight.’
Some jollity between the porter and the nurse was like people talking a language she could not understand. Sweating, she wished to scream for help. The threshold of the glass doors bumped; the lift bumped; each bump was a point of torture.
In the anaesthetic room she held out her arm eagerly. ‘They aren’t ready,’ warned the technician. The charming Indian girl who was the junior anaesthetist smiled down at her, but her charm was wasted, she seemed merely a gaoler, holding tight the door of the torture chamber, ‘Onl
y a minute ‒ two minutes,’ she smiled. Two minutes ‒ it was an age! The patient looked at her with pleading eyes. Then at last— ‘Close your fist.’ The rest was blessed oblivion.
The patient was wheeled in and put on the table; I counted my swabs with my runner, a rather frightened-looking staff nurse. She poured out the skin preparation, and I put some swabs on the forceps ready to use to clean the skin. The sterile towels that had been wrapped round the broken hip in the ward were removed; the runner brought fresh ones, green hip towels, long, all-enveloping, with a slit in the middle to surround the operating site; further small ones to put all round the body, as it was put in position on the table. The inert form was kept in place by table fitments screwed on to the frame, for the unnatural position to facilitate surgery must be well supported; pressure on the nerves could result in paralysis.
I was surrounded by three trolleys when Camden came in frowning under his theatre cap and over his mask. His cold-looking eyes seemed to glance round the room as if looking for something to complain about. But then, to my surprise, he came up to me and said mildly; ‘Good morning. You must be the new Sister.’
His eyes, I saw, were not really cold, only rather sad. I took courage from his obvious desire to start on the right footing.
‘Good morning, sir,’ I said politely. ‘I’m afraid this is a new branch of surgery to me. Would you mind telling me if there is anything special you want, or if you use anything out of the way in sutures?’
He gave a quick glance at my trolleys; the first one had knives, scissors, dissecting forceps, artery forceps, the rarely used tissue forceps, and the large retractors. The next one had all the bone instruments; chisels, mallet, osteotomes, a set of Smith Peterson pins; the final trolley had the Desoutter drill, sitting smugly by itself, a thick rubber hose winding off the trolley ready to be attached to the oxygen cylinder that would drive it when the trigger was pressed, The drills and metal key to insert them were in a kidney dish by the side.
‘No, it all looks in order. I don’t think I’ll want the Desoutter, though I always like it about,’ he added hastily, ‘in case I put a plate on.’
The operation began. An incision was made, and a Smith Peterson pin hammered into the head of the femur with a mallet. An X-ray photograph was taken, and the pin found to be in the right position.
The runner, who had looked scared and hopeless, turned out to be a tower of strength to me. Without her there would have been several hitches, and hitches in a delicate operation of this kind increase the tension unbearably. ‘Mr Camden always paints three times,’ she murmured, as I prepared to abandon the sponge forceps. ‘Er ‒ he prefers the heavy mallet.’ ‘He sometimes helps himself to the sutures ‒ if you put them on the other trolley.’ She was always one step ahead in her advice, and she always sounded humble and embarrassed at having to give it.
Towards the end of the operation Maitland suddenly sidled in through the scrub-ups. She spoke to the runner who blushed, to a junior who fled, and to the pretty woman anaesthetist who frowned and shook her head. Then she came to stand opposite Camden, waiting to catch his eye.
He spoke to me without noticing her. ‘Thank you, Sister,’ pleased at a prompt presenting of some forceps. ‘Really, you know, this is a job that can be made so much easier if you have a good theatre assistant. Take this morning, for instance ‒’
I handed him some catgut on forceps for tying off an artery. ‘No, no, dear. I think I’ll have a bit thicker for this one.’ Catching sight of Maitland he said cheerfully, ‘Hullo, Sister, I’ve never had such treatment in my life ‒ feel like royalty. I call this a well organized theatre.’
It was meant as a compliment to her, but as such it fell flat. She did not answer, or make any sign that she had heard him, but turned round and slid out.
The operation was finished, sewn up, dressed; a layer of plaster was applied and the plastering finished by the house surgeon. The inert body was removed from the table, the runner took the trolley out and Fred the porter pushed it back to Ward B2, with the runner walking beside.
The body, still inert and unconscious, became Mrs McKie, and was received tenderly by Sister Sadd, and arranged in bed with the plastered leg outstretched, and a cage over it.
I hardly saw Maitland all day. She seemed to want to avoid me, and for my part I wanted to see as little of her as possible. That evening I went into the office to get the list of the following day’s operations. She was putting her cloak on.
‘I’m off now, Nurse ‒ er ‒ Sister,’ she said curtly.
I merely nodded. Two could play at this game of indifference, I thought.
‘Oh, by the way,’ she added casually, turning with her hand on the door knob, ‘someone rang you up last night when you were at supper.’
I looked up, startled. ‘Who?’
‘Oh, Ron or Don or some such name. He wanted you to get in touch.’ Before I could react to this news, or note that she had not even apologized for not giving me the message, she was gone.
I went to bed early after speaking to Don, but I could not sleep for hours. The hazards of the day, now they were safely over, seemed more tremendous than they had seemed at the time. Maitland’s crime seemed worse. Supposing Don’s mother had died because of some ignorance or stupidity on my part?
I thought of Don, kind and strong, always bearing other people’s burdens. I went to sleep thinking of him; I had not seen him for a week, and yet he seemed closer to me than he ever had.
The hospital went to sleep too; its partial, watchdog sleep with one eye open. Lights were put out in the wards, the windows in the corridor were slammed and bolted for fear of prowlers. In Casualty the Duty Officer yawned and the nurses packed drums and rolled bandages. The Night Porter read Amateur Gardening, the Night Superintendent walked her rounds in her dark cloak with a ward nurse in step beside her. In the ward offices senior nurses sat writing reports, while in the kitchen the juniors laid breakfast trays. An ambulance rolled up and two men carried a stretcher with an unconscious figure on it down the corridor to the Male Surgical Ward, to be met by an angry nurse calling for a fracture board and asking why County hadn’t had the decency to let her know …
In the end section of Ward B2, Mrs McKie woke to hear a cry of ‘Oh, Oh’ ‒ and to realize the cry had come from her own mouth, an involuntary cry of pain on involuntary movement. The screens were partially drawn round her bed, but opposite she could see a girl sleeping soundly. She had time to envy her before pain and sickness swept in like a tide.
A nurse appeared on each side of her; her head was held. ‘Breathe deeply, Mrs McKie, dear.’
In the half-light she could see them, nice girls with bright eager faces under caps, one fair, the other dark. They were kind and attentive, and she would have liked to obey them, but she knew it was useless; the deadly sickness continued in obedience to some inner revolt.
Later she lay quietly, thinking of her family. She watched the sleeping girl opposite, wishing she too could sleep the bad time out. There was something to be gone through first with the best face one could put on it, before one reached that peaceful stage on the road to recovery.
Dozing and crying out, apologizing as they came to her, dozing again; at last it was obviously morning. Nurses moved around. There was a rattle of trolleys. A cup of tea was given her. The girl opposite, sitting up perkily, was saying; ‘Morning, Nurse, morning all, I’ve had a terrible night.’
Is that, Mrs McKie thought in amazement, what they call a terrible night?
Chapter Five
With detachment, wrapped in a casing of her own discomfort, she heard the life of the ward go on around her.
Nurse Brunton brought her a basin of warm water and she struggled to wash, while Nurse went on to Grannie Weedon. The old lady was sitting up, her white hair straggled, her old face wrinkled and anxious.
‘Poor old duck, poor old dear. Sit right up, I’ll be washing you. It’s a lick and a promise for you today, Gran.’
The
old lady, unused to being waited on, had to justify herself. ‘I’m not one for a lie-in in the morning. I been up and done all the work.’
‘Is that right?’
‘I’ve swep’ and done the fire. I got the breakfast.’
‘Aren’t you clever then? But see, have ye been out and done the shopping?’
This simple query was rather a facer to Gran; her mind seemed to creak in its efforts to adjust. ‘I don’t think,’ she said doubtfully, ‘I don’t think I done that yet.’
‘Ah ‒ ye’ll have to run out quick and do the shopping or there won’t be a thing to eat in the house.’
Nurse Brunton, passing round the bed, gave Mrs McKie a wink and then yawned, as if saying ‘anything for a bit of fun after a dull night.’
The Bunion, whose name was Miss Caulfield, put in helpfully; ‘She don’t know where she is, thinks she’s at home, likely.’
This sage comment was ignored by Nurse Brunton, who whipped up bowls and hurried off.
Miss Caulfield drank her tea and then got a writing pad out of her locker. ‘I writes to Mum every day,’ she announced.
No one made any remark. Mrs McKie, exhausted, lay back on her pillows. Gloria was sorting out a bundle of magazines. Grannie Weedon was sitting rigidly staring into nothing and champing her false teeth.
‘What day is it, please?’ asked the slow, polite voice of Miss Caulfield.
After a pause, Mrs McKie answered her. ‘What day? Oh, I think it’s Friday.’
‘Thank you.’ Miss Caulfield looked up from toiling at the slowly formed letters. ‘What is this place, please?’
‘Um ‒ Fawley Grange Hospital.’
‘Fawley Grange? How do you spell it, please?’
Mrs McKie told her, and there was a long, long pause, during which Gloria finished one True Story and started another, and Mrs McKie drifted into a doze. Then the polite, uncertain voice began again: ‘How do you spell “hospital”, please?’
‘Crumbs, don’t you even know that?’ said Gloria rudely.