She smiled. ‘The attraction of a teaching hospital, as far as potential nurses are concerned, is rather more basic, Dr. French.’ She saw momentary surprise on his face, and was amused.
‘That isn’t to say that a certain type of girl—the well educated thoughtful girls, who are the ones we most want to attract, would not in fact find a promise of lively interest in working with a piece of original research,’ she went on smoothly, and saw French’s shoulders relax slightly. ‘Really, it was almost like playing a fish,’ she thought maliciously. ‘I’m not sure I want to attract the girls who go to the teaching hospitals because there are rugger playing medical students about to enliven the scene——’
There was a ripple of laughter, and she smiled at the men round the table, pleased with herself.
‘As I see it, the question I must answer is: will the presence of mentally ill patients in the Royal upset the existing staff, and cause some to leave? And could such upsets lead, in turn, to a diminution of new applications for training?’
‘Exactly,’ Sisson said, looking at her in approval. ‘You’ve hit it on the head, Matron. Now, a gastro-intestinal ward——’
‘Forgive me, Dr. Sisson.’ Elizabeth’s interruption was polite but firm. ‘I only put the question. I haven’t yet answered it. Before I attempt to do so, may I ask a rather important question?’
French was staring at her in puzzlement. He had been almost certain, since their conversation at his house, that she would co-operate with him. What was she trying to do now? Show him her independence, show him she had not in fact been inviting him to pick up their old friendship?
‘Bloody devious bitch,’ he thought, with sudden venom. ‘She’s enjoying this——’
‘By all means, Matron.’ Heston sounded very agreeable, but he injected a sense of ugency into his voice. It was getting late, and the yellow lights over the table showed their reflections in the dark panes of the window, reminding him that it was past five o’clock, and time he was at home.
‘How essential is it that you reach a decision on this matter today?’
Heston looked round the table. ‘Not essential today, I suppose. It would be rather better to deal with it now if we could. There is always so much to do, and time is always at a premium——’
‘I realise that. It’s just that I feel it would be wrong of me to offer an opinion about this matter without having the opportunity to—sound out senior nursing opinion. As Matron, I must of course remember that I speak for all the nurses and their interests—and I hope I am no autocrat. I would much prefer to ask you to put this matter in abeyance, until I can give you an answer that would be of real value to you. If I produced a facile reply at this point, I would be in danger of misleading you. I don’t want to do that. So——’
‘Very wise, Miss Manton, very wise. It was hardly fair of us to ask you for a judgement on such an important matter so soon after your appointment.’
Heston looked severely at French, but French, now looking down at his papers, paid no attention to him.
‘Shall we leave this over to next month, then, gentlemen, and give Miss Manton a chance to sample opinion? Perhaps you will report back to us then, Miss Manton——’
‘Thank you,’ Elizabeth said. ‘I hope Mr. Sisson, Dr. French, you will forgive me for this delay?’ It was French she looked at, and he raised his eyes. ‘I would not wish to—jeopardise your interests in any way, by being too precipitate.’
French smiled now. ‘Of course, Miss Manton. I for one fully appreciate your—wisdom. Sisson?’
‘I suppose so,’ Sisson said sulkily, and stood up. ‘Leave it like that then. Unless someone wants to nominate and second Jamieson’s application?’
He sounded belligerent, and there was an awkward silence, while Jamieson sat quietly. He was happy enough to have scored off Sisson, and made no attempt to push his own application any further.
‘All right then, I’m going, Heston, unless there’s something under Any Other Business. I’ve got work to do if no one else has.’
‘I don’t think so,’ Heston said, only too glad to end the meeting, ‘I’ll notify you all of the date of the next meeting, gentlemen, Matron.’
The room emptied rapidly, Sisson pushing in front of Jamieson as he went, his whole body rigid with dislike of the other man.
Elizabeth watched them go, still in her chair, and looked up at French, who was taking his time over collecting his own pile of papers.
‘Do they always treat each other so—in such a cavalier fashion?’
‘Frequently,’ French said, and waited until they were the only two people left in the room before turning his body so that he could sit on the table, one leg swinging as he looked consideringly at her. She sat quietly, smiling in friendly composure.
‘I had hoped for more—shall we say, co-operation?—this afternoon, Elizabeth,’ he said softly.
‘But my dear James, I gave it, surely?’
‘Did you? Perhaps I’m being obtuse, then.’
‘I rather think you are. You didn’t honestly expect me to jump on my chair and shout “Up with French, down with everyone else” did you?’
He laughed. ‘Hardly. But I did think——’
She stood up, and spoke with some briskness. ‘It would have been foolish in the extreme if I had answered the question about the nursing attitude to your plan. After just a week, how could I? If I’d come down on your side, surely the committee would have suspected collusion between us? You mustn’t forget, Heston knows we are—old friends. Do you suppose he hasn’t told others that? You mustn’t underestimate his taste for gossip, or your colleagues’ powers of intelligent surmising. You surprise me, James. I thought you were more patient.’
He rubbed his face, staring at her over his fingers, his eyes calculating.
‘I see. You—are not then, going to—shall we say, oppose me?’
‘I can’t ally myself on one side or the other just like that, James—you must see that. I have a job here, a responsibility to the hospital and to this committee. You wouldn’t ask me to make snap judgements that would go against that responsibility, now would you?’
‘You’re quite right, of course. I suppose I am being impatient.’
‘Ambition always is.’
‘It wouldn’t be ambition if it weren’t——’
She turned to go, and stopped at the door.
‘It would be a great help to me, in sounding out the nursing opinion on your idea, if I understood it in more detail.’ She smiled at him with great charm. ‘Perhaps you could find time to talk to me about it?’
‘By all means.’
‘Perhaps—shall we say next Friday? In the evening? If you could dine with me in my flat, we could be sure of—talking without interruption. Does that sound possible? During the day, I’m very busy, and of course, you are too. As long as Jennifer wouldn’t object, that is.’
He was still sitting on the table, his head in a nimbus of light that effectively shadowed his face.
‘Friday? To talk about my idea? I don’t see why not. May I discuss her plans with Jennifer? As long as she hasn’t already arranged something for us, we would be delighted to come. Thank you.’
‘Oh. Yes, of course. I’ll be happy to see you both, then.’
‘Of course, Jennifer will find our discussion desperately boring. May I suggest, if it isn’t an imposition, that you include another person in your dinner party? That would give us a chance to talk without neglecting Jennifer’s interests.’
‘By all means,’ she said smoothly. ‘Friday, then, about seven thirty. Good afternoon, James.’
And she went, leaving him with a smile on his face.
‘One to him,’ she told herself savagely, as she reached her office and prepared to interview Miss Baker about the next day’s appointments. ‘But the next will be mine, so help me it will.’
EIGHT
‘I shall have to do something,’ Elizabeth thought irritably. ‘All she’s doing is par
ading her obsessions and enjoying it, and I’m getting nowhere. And she’ll just go on as she always has, and if I try to bring this subject up again at another discussion, she’ll think I’m making a butt of her. I’ll have to do something——’
But she sat silent still, watching Josephine talk while she steadily ate her way through the major part of the box of chocolates she was sharing with Mary Cotton, and described in great detail her method of linen cupboard arrangement.
The first of the sisters’ discussion group meetings had been going on now for more than an hour. They had been tense at first, unwilling to talk much at all, and had passively accepted Elizabeth’s suggestion that she should be the chairwoman for the first meeting, not even Dolly East attempting to argue. They had accepted Elizabeth’s choice of subject—the place and uses of routine in hospital work—with equal passivity.
She had tried, at first, to get them to talk of the deeper implications of routine, but she had failed. Josephine had ridden over her attempts, not because she understood what Elizabeth was trying to do (and that’s the whole trouble with her; she just can’t comprehend what I mean, Elizabeth had thought), but because for Josephine, routine meant only the technicalities of ward planning, nothing more.
‘At least they’ve relaxed,’ Elizabeth thought now. ‘She’s made them feel safe. They were frightened they’d display too much of themselves, and she’s lulled them with all her dreary nattering about lists and rotas. She’s been useful after all, perhaps. Now they’ve relaxed, I might get somewhere. But I think I’ll have to do something fairly brutal——’
Josephine took another chocolate, and almost beamed round at the group of women, at Daphne and Susan sitting side by side, at Dolly in the self-imposed discomfort of a hard backed chair, at McLeod and Arthur and Cotton half asleep in their armchairs, at Swinton slightly removed from them in the window seat.
‘Anyway, that’s how I do it,’ she finished. ‘But if anyone has any better ideas, I’m more than willing to hear them. No one can say I’m not open to suggestions, if they’re good ones,’ and she looked sideways at Elizabeth to make sure she had observed this statement of willing pliability.
‘Has anyone anything to add about linen cupboards?’ Elizabeth said. ‘No? Good. Because now we have dealt with some of this detailed matter, perhaps we can get on to what is really rather more interesting and important. That is, the uses of routine.’
‘I thought that was what we were talking about,’ Dolly said, almost rudely. ‘We’ve heard nothing but how to use a routine since we started.’
‘Only details,’ Elizabeth said. ‘Only details. But as I see it—and you can argue with me if you disagree—routine has other functions. It can be a comfort.’
‘Oh, I agree,’ Josephine said at once. ‘The patients are far more comfortable when you have a well run ward because nothing is left undone. Everything is planned for—back rounds, bedpan rounds——’
‘I don’t mean in that sense,’ Elizabeth said with careful patience. ‘Isn’t it possible that a routine is a comfort to the people who administer it?’
‘Of course it is,’ Josephine said, eagerly. ‘Of course it is. I would worry very much indeed if I thought any part of our nursing care had been forgotten——’
‘Again, Sister, you misunderstand me,’ Elizabeth said, a little sharply, ‘I am suggesting that a sister’s routine protects her from some of the deeper implications of her work. Just think about it. We are faced every day with pain, with unhappiness, with death and grief and loneliness. We have to face these things, help the sufferers, but not get involved with their suffering as human beings, don’t we? If we work to a strict routine, then the routine can become an end in itself, become more important than the people it is supposed to serve—important to the nurse who uses it, because while she uses it, she need not concern herself with her patients and their misery. Don’t any of you feel that?’
‘I rather think I do,’ Daphne said, unexpectedly. ‘Come to think of it, I’ve got a pretty fixed routine in the theatres, of course. You’ve got to have one in such a technical sort of department. But there’s more to it than that. There is a lot of emotional strain in the theatres—of course there is, and a well planned system takes the edge off. If you’re thinking about the routine, you haven’t time to worry about the cases as patients. I could worry about them, if I let myself, you know. I’m not all technician, whatever some of you may think. There was that girl who had primaries in her liver—do you remember, Pip?’
‘I remember,’ Susan said. ‘She was just a kid, wasn’t she? It was a few months ago. This girl was about twenty—pretty little thing she was, and she went to theatre for a laparotomy and they just had to sew her up again—there wasn’t a thing they could do, and Daphne here was really cut up about her——’
‘She died,’ Ruth said. ‘Judith Levy, her name was. Her mother nearly went stark staring mad all over my kitchen when she died. I won’t forget that one in a hurry either.’
‘Well, that one upset me,’ Daphne said. ‘And I wasn’t much use around the place for days after that case. Well, you can’t be like that, can you? Getting all het up all the time about the patients.’
‘We make progress,’ Elizabeth sounded brisk. ‘Nursing, as I said, can be painful. We see things, hear things, that hurt us as people. With a routine we can protect our feelings. We lessen the stress on ourselves.’
‘I think that’s ridiculous,’ Dolly said flatly. ‘A lot of sentimental rubbish. We’ve got a job to do, and that’s all there is to it. I’m sure I’ve more sense than to get sentimental over the patients. The world’s full of these sad cases. Hospitals don’t have a monopoly of them. You make us sound like a lot of babies who need Mother to keep us happy by putting us down for a nap at the same time every day. It’s almost insulting.’
‘That’s what I think,’ Josephine said, her face reddening, carefully not looking at Elizabeth. ‘All this deep psychology— well, really, Matron, you’ll forgive me, but I think all this is just looking for something that isn’t there. I care a lot about my old women. I certainly don’t have a routine to stop me from caring about them. I have it so that I can do the best for them.’
‘Now, Jo, just a minute.’ Swinton spoke for the first time that evening, startling them a little. ‘You know you get into a flap about things, and that you sometimes have trouble with your nurses because of it—your routine, that is. You run that ward like clockwork. If something happens to change your system, you get into a tremendous state.’
‘Well, I know that—I can’t deny I get upset when it goes wrong. But only because I like everything to be nice——’
‘Well, isn’t that what we’re saying? I think Matron could be right. In fact, I’m sure she is. You’re an obvious case, aren’t you? Your routine’s an end in itself to you, and I think it’s because it makes you feel better, not because of the patients, even though you think it is——’
‘That’s not true! Of course it isn’t—I just—I——’
‘I think it’s true of all of us to a greater or lesser degree,’ Elizabeth said carefully.
She leaned back in her chair, and stared up at the ceiling as she spoke, picking her words carefully. ‘Look, just as an exercise, let’s see if we can define the extremes of this. Let me tell you how I visualise the sort of nurse who has a positive need for a rigid routine as an end in itself rather than as a useful tool. I see her as a somewhat-obsessive personality. She will show herself to suffer from a sense of insecurity off duty as well as on. She may, if she is really unfortunate, develop an addiction—drink, drugs—and of course drugs are all too easily available to nurses—food——’
‘Food?’ Daphne said, and then laughed. ‘Oh, Matron, that’s a lovely thought. Quick, give me a great big sandwich. I feel a stress coming on——’
‘It may sound funny, Sister,’ Elizabeth said. ‘But it is true. Food is a great comfort to many people. And it’s logical it should be. Think of babies. All they
want is food, whatever happens. And because it is mother who gives them their food, they come to equate it with love and security. Some people, who for one reason or another don’t progress beyond this stage of emotional development, never lose this infantile need for food. They use it just as alcoholics use drink, or drug addicts use their heroin or whatever—a bulwark against unhappiness——’
‘Poor old Jo. Got you in one,’ Ruth Arthur murmured, and laughed.
There was a sharp silence, and Elizabeth looked round with a display of innocence. Josephine’s face had gone a patchy red, and she was sitting very straight. Arthur was looking at her with a rather malicious amusement on her face, and Mary Cotton had an expression of almost ludicrous anxiety on hers as she sat beside Josephine, carefully not looking at her.
‘I didn’t quite catch that, Sister Arthur——?’ Elizabeth said, also trying not to look at Josephine.
She had led the talk towards this attack on Josephine carefully, because it had been necessary. If she’s ever to get any benefit out of all this, she’s got to be made to understand, Elizabeth told herself defensively. She’s got to, for her own sake. But it wasn’t a pleasure to do it. She could feel Josephine’s shock and distress as though it were her own, as though someone else had said to her, Elizabeth, ‘You are an immature, obsessive character, and not much more than a joke——’ For a moment, she regretted her action, and wanted to sheer away, to leave things as they were. But that would be pointless, she thought quickly. Pointless. I’ve done it now, and if I don’t follow it through, it makes it just a piece of gratuitous cruelty. I must follow it through. ‘What did you say, Sister Arthur?’ she said again, and raised her eyebrows in interrogation.
Ruth shrugged, embarrassed now, but Elizabeth still sat with her eyebrows raised, waiting for an answer.
‘Oh, I didn’t mean anything at all really,’ she said uncomfortably. ‘Just chattering. I didn’t mean anything.’
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