A Nurse's Courage

by Maggie Holt

  ‘I’d better be gettin’ back, Stephen. Violet’s goin’ to take me to –’

  ‘No, not yet, please, we’ve only had half an hour!’

  ‘Stephen, I think it’s best if we didn’t.’ She broke off awkwardly and felt her face blush scarlet. ‘Yer know how it is in hospitals, people are always talkin’. An’ I don’t want ’em talkin’ about you.’

  He looked at her blankly. ‘What do you mean? Don’t be ridiculous, Mabel! We’re old friends – we’ve known each other for years, for God’s sake.’

  ‘Yes, but you’re a married man, an’ it’s best not to give waggin’ tongues a chance, so if yer don’t mind, I think I’d better go back – on me own.’

  ‘I can’t believe I’m hearing this. I don’t believe you’re doing this to me. I need you, Mabel – yes, I need you, can’t you see?’

  ‘Ye’re a married man, Stephen. An’ soon ye’ll be a father. I must go.’

  She shook herself free of his arm, and without another word turned away and left him standing alone. She did not look back.

  Tears blinded her eyes as she hurried up Glamis Road, telling herself that she was doing the right thing. In fact, the only thing to do.

  Chapter Nineteen

  STAFF NURSE COURT gave a gasp of dismay on hearing that she was to be posted to Mary Ward where the diphtheria outbreak was being contained.

  ‘I’m sorry to take you from Heckford where you have done excellent work, Nurse Court,’ said Matron Rowe, ‘but a staff nurse on Mary has contracted diphtheria and the pressure on the staff is very great, so I really have no choice but to send you as a replacement for her. You may remove your belongings to the special staff quarters this afternoon and commence duties tomorrow at seven thirty. Thank you, Nurse Court, you may go.’

  Mabel contemplated the disadvantages of this sudden announcement. She would only be allowed to leave the hospital on one day a week, after taking a bath and changing all her clothes. Her visits to Harry would have to be curtailed and she would not be able to go to the Midway Babies’ Home at all. She would see even less of Maud than she did at present and – ah, yes, another thought came to her: Dr Stephen Knowles’s work in surgery and theatre kept him away from Mary Ward and that at least was a relief.

  As soon as she began her new duties, she was swept up into a tightly knit working team in which each member had a part to play.

  ‘The earlier treatment is begun, the better the chance of recovery,’ Dr Dunn frequently told the staff. Complete bedrest was essential, and the nurses had to observe and record pulse rates, swelling and tenderness of the neck, croupy coughs and running noses. They made regular examinations of the patients’ throats, looking for redness and early patches of the dreaded diphtheritic membrane. Frequent small drinks had to be given – egg beaten up in milk was the staple food – and the air was kept warm and moist by fish kettles continually steaming at each end of the ward. The doors were hung with sheets soaked in disinfectant solution. Hands had to be washed before and after attending to each child, and became rough and sore; nurses were advised to smear Vaseline on them and put on cotton gloves before sleeping.

  ‘Once we’ve nursed our child through the first week, he must remain on bedrest for a month before we can say he’s cured,’ said Dr Dunn. ‘The two great complications are heart failure and paralysis.’ So the children still had to be fed and toileted in bed, with the nurses constantly watching for blueness of the face, ears and fingers, drooping eyelids, limp legs and feet. And in spite of no other treatment being available, the mortality rate for diphtheria at the East London was comparatively low, thanks to strict adherence to these rules. During Mabel’s first week on Mary there was only one death, a boy of five admitted in an advanced stage of the disease, the diphtheritic membrane having spread over the back of his throat.

  It was the Ward Sister who casually mentioned one morning that Dr Knowles’s wife had given birth to a daughter on September the seventeenth.

  ‘I heard it from Sister Enfield yesterday. Let’s hope it will help him to settle down. He’s changed from the man he was before he went abroad, and not for the better,’ said Sister Mary a little sourly, and Mabel wondered whether the words were meant for herself. It was good news, of course, and she could only echo the Sister’s sentiments in her heart.

  It was time for her first day off. She took her obligatory bath, put on clean underwear and her navy suit, and set off to visit Harry; but on the way she called in at South Lambeth Road to catch up with Maud Ling who welcomed her with a hug.

  ‘Good to see yer, gal – it’s been so long, I was wonderin’ if I’d said summat to upset yer.’

  ‘Oh, don’t be daft, Maudie. I’m sorry, I’ve been on the diphtheria ward and it’s ever so strict.’

  ‘I’ll put the kettle on, an’ we’ll ’ave breakfuss.’

  ‘Haven’t yer had it yet? It’s nearly noon!’

  ‘Yeah, well, I didn’t feel like it. All right now, though.’

  Mabel was at once alarmed. ‘Are yer all right, Maudie?’

  ‘Missed me August red-letter day, gal, that’s what.’

  Mabel stared at her aghast. ‘Oh . . . oh, Maudie dear. How many days?’

  ‘Free weeks. An’ queasy wiv it. I know it in me bones, Mabel. I’m expectin’.’

  Sorry as she was about her friend’s predicament, Mabel was not really surprised. It was something she had been dreading ever since Maud’s liaison with Alex Redfern.

  ‘I’ve used the vinegar sponge most times, an’ it’s worked all right so far – but there wasn’t a chance to put it in that last time,’ said Maud gloomily.

  ‘So what’re yer goin’ to do, Maudie – tell Alex?’

  ‘Nah, not yet. Not ‘til ’e can see for ’imself. Not before Chris’muss.’

  ‘But ye’ll be showin’ by then, if ye’re already a month gone. I mean, it’ll be due in – er –’

  ‘Some time next April, yeah. An’ the war might be over, or – yer know, I never wanted to trap ’im, gal. ’E don’t ’ave to marry me, an’ maybe ’e won’t want to – but I’ll ’ave ’is child to remember ’im by.’

  Mabel was impressed by Maud’s stoic realisation that she might find herself left alone. So much now depended on Redfern’s loyalty towards his faithful cockney girl.

  ‘Er – are yer goin’ to say anythin’ at Elmgove?’ she asked tentatively.

  ‘Don’t make me laugh – what, after the way she spoke to me? I wouldn’t go near ’em.’

  ‘But his mother might feel differently if she knew yer were carryin’ his child –’

  ‘She won’t get the chance – it’s what she fought I was talkin’ abaht, even before I knew it’d ’appened. No, Mabel, I’ll carry on wiv Chu Chin Chow for as long as I can, an’ then I’ll ’ave to get some ovver job. It was a bit of a shock at first, but I won’t be the first, nor yet the last. Ovver women’ve managed, an’ so can I.’

  ‘But Maudie –’ Mabel decided to say no more for the time being. It was early days yet. A lot could happen before the spring: a miscarriage, perhaps, or even a hasty wedding, especially if the war ended. But it was a very uncertain prospect: a penniless unmarried mother with no parents to assist her would be a social outcast and the future of her child decidedly bleak.

  ‘Now, listen to me, Maud Ling, I’m goin’ to take yer in hand,’ she said briskly. ‘Yer got to start takin’ proper care o’ yerself. Get rid o’ that gin bottle for good and drink milk instead. Make sure yer get enough rest, don’t wear anythin’ too tight an’ keep yer bowels reg’lar.’ She laughed, determined to be hopeful and optimistic in spite of her own misgivings.

  ‘Oh, Mabel, yer always was a good ’un – best friend I ever ’ad.’

  Maud’s eyes were moist as she hugged her friend close again, hiding the fear in her heart.

  Night, a three-quarter moon and silence over the river: from the south windows of Mary Ward could be seen the forest of masts in the Shadwell Basin. In the dimly lit ward the only s
ound was the painful rasp of little Tess Graves’s laboured breathing. Nurse Court stood over the cot and regarded the child, not five years old and fighting for breath, her eyes looking up in mute appeal. Beside her sat her mother, Susan Graves, who had been snatched from the very jaws of death three years previously at the Booth Street Poor Law Infirmary. Now her daughter lay dangerously ill, a steam kettle hissing beside her cot; at first her breathing seemed to ease a little in the stream of warm, moist air, but now as Mabel looked into her mouth, pressing down the tongue with a spatula, she saw that the membrane had spread, an obscene, pale, leathery growth across the whole of the back of the throat.

  Susan Graves looked up beseechingly at Mabel. Like the nurse, she was wearing a white cotton barrier gown and a face mask over her nose and mouth.

  ‘Can’t yer do anythin’ for her, Nurse Court?’

  Mabel straightened up. ‘I’ll send for the doctor on call, Susan.’ She felt unable to give the young mother much hope. It was just after half past one. In an hour or two more, the diphtheritic membrane would close the airway completely. It was a dire emergency and the treatment was hazardous.

  The telephones installed on each of the wards were a boon for summoning doctors, rather than having to send porters with messages.

  ‘It’s Mary Ward,’ said Mabel to the woman on the hospital switchboard. ‘Can Dr Cuthbert come at once? I think we’re going to need a tracheotomy here.’

  Having made the call, she quickly prepared a tray for the procedure, setting out the sterile silver tracheotomy tubes, inner and outer, on a huckaback towel. A bowl of antiseptic lotion, another of saline, gauze swabs and thin sponge holders were added – and the knife with its sharp new scalpel blade.

  ‘Mabel.’

  She jumped at hearing her name and looked up to see Stephen Knowles framed in the doorway of the treatment room.

  ‘I see you’re preparing my fate,’ he said.

  ‘G-Good mornin’, Dr Knowles. I was expectin’ Dr Cuthbert.’

  ‘Has had to go home to his father, sounds like a stroke. I’m standing in as duty officer. And Dr Dunn isn’t in the building. Have we got time to send for him?’

  ‘I don’t think so. Ye’d better come an’ see little Tess Graves, five years old, diphtheria, third day. Her mother’s with her.’ Mabel was breathless with anxiety. ‘I’m sorry, I should’ve sent for yer before, but an hour ago she wasn’t this bad.’

  ‘Hm-mm.’ He tied a face mask on and donned a barrier gown. Mabel sketched in the child’s history as she tied up the tapes at the back. She led him to the cot where he nodded to Susan Graves, drew in a long breath and let it out in an audible whistle.

  ‘Tracheotomy straight away. Get her into the treatment room.’

  Mabel lifted Tess out of the cot and Knowles spoke to the mother. ‘You stay here while I see what I can do for your little girl,’ he said.

  ‘Oh, let me come, please, doctor, I’ll hold her for yer, she’ll be better if I’m there – please!’

  ‘I’ll examine her first, and then let you know.’

  He turned on his heel and followed Mabel who laid the child upon the treatment couch.

  ‘Say a prayer for her, Mabel,’ he muttered grimly. ‘And for me while you’re at it.’

  ‘Have yer ever done one before?’ she whispered after she had closed the door.

  ‘No. Seen a couple, though. The trick is to avoid the major blood vessels, they’re all over the place. Nick the jugular and that’s that.’ She knew that he was afraid.

  Beneath the electric light, Tess tried to cry out, but only managed a faint wheeze. Her little face was blue, her eyes staring from their sockets.

  The door opened and Susan Graves appeared. ‘Let me stay with her!’

  Mabel caught Stephen’s eye and he shrugged, leaving the decision to her.

  ‘All right, Susan, yer can hold her still,’ she said, offering up a desperate prayer that the mother was not about to see her child killed like a sacrificial lamb.

  Knowles picked up the knife. Tess’s windpipe was visible under the skin, though the swelling of her neck on either side made it difficult to ascertain the exact position of the blood vessels.

  ‘So easy when you look at diagrams,’ Knowles murmured under his breath. ‘There’s the trachea, there’s the thyroid gland, there are the arteries and jugular veins on either side . . . but when a kid’s lying in front of you, swollen and gasping for air –’

  ‘May the Lord guide yer hand.’ Mabel stood on the opposide side to him, gauze swabs ready to mop away the blood. Susan Graves had one hand on her daughter’s chest, the other on the top of her head.

  Knowles placed two fingers on the windpipe and felt for the fourth and fifth rings of cartilage. Keeping exactly to the middle line, he quickly cut a small vertical slit in the skin. A little blood oozed out, and he then drove the knife through the hard cartilage: immediately there was a soft hiss as air was sucked in through the opening just made. Mabel dabbed at the oozing blood, and he put down the knife and picked up the curved silver tracheotomy tube, inserting it into the hole so that it curved downwards. The rasping noise had stopped, to be replaced by a regular whooshing sound as air passed in and out through the tube.

  ‘Done it.’ He almost groaned. ‘Mabel, we’ve done it.’

  They raised their eyes and Susan Graves sobbed with relief. ‘Thank yer, doctor, thank yer, Nurse Court, thank yer, thank yer!’

  Mabel handed him the inner tube which he thrust inside the one already in situ. The whoosh-whoosh-whoosh of air flowing in and out of Tess’s lungs was music in their ears.

  ‘Good girl. Got the tapes ready? And a dressing to put round the tube. Old Bob Parker must be looking down from the stars at us.’

  Mabel smiled. The distinguished surgeon Robert Parker was one of Shadwell’s great names and his work on tracheotomy a milestone, along with the tube he had designed and perfected.

  Mabel put a gauze dressing over the tracheotomy and threaded white cotton tapes through the flanges of the outer tube, to tie round the neck and keep it in position.

  ‘Thanks be to God.’ Mabel’s silent prayer rose straight from her heart.

  ‘Couldn’t have done without you,’ she heard him mutter. ‘Wouldn’t have had the nerve.’ He was wet with perspiration and strands of grey hair clung damply to his forehead. He raised his arm and wiped the moisture away with his elbow.

  ‘Better keep her here under observation for a bit.’ Turning to Susan Graves, he spoke solemnly. ‘Your little girl stands a chance now, but she’s by no means out of the woods. You do realise that, don’t you? She’s very sick with diphtheria and the next forty-eight hours will be critical. I can’t make any promises, Mrs Graves.’

  ‘Oh, but she’s breathin’, doctor, an’ she’s sleepin’,’ whispered Susan, her eyes shining through tears. ‘She’s goin’ to get better, thanks to you an’ Nurse Court, I know she is, I just know it – she’s been spared to me.’

  What answer could there be to that? Mabel told the second-year to go and put the kettle on for tea. They could only hope and pray that Susan was right, and that her little girl would indeed recover. Without the tracheotomy she would certainly have been dead before morning, but now there was hope.

  Twenty minutes later Mabel carried the sleeping child back to her cot.

  ‘Ye’ll be wantin’ to get back to yer bed, Dr Knowles,’ she said.

  ‘Is there another cup of tea?’ He was in no hurry to leave. She refilled his cup and passed it across the kitchen table. ‘An’ how’s your little girl?’ she enquired.

  ‘All right from what I’ve heard. It all went off well, apparently.’

  ‘What’re yer callin’ her?’

  ‘My wife has called her Lilian, so I suppose she’ll be Lily.’

  ‘And don’t yer want to see her, Dr Knowles?’

  He ran his fingers through his hair. ‘I can’t picture any life apart from here, Mabel. To go careering up to Northampton on a short trip wouldn’
t be worth it, I simply wouldn’t belong. My wife’s parents don’t think a lot of me and it might do more harm than good. I’m going to have to wait until after this war to start building on the life I had before. If that’s possible.’

  ‘But – yer own little daughter –’ Mabel began, but he cut her short.

  ‘Is in the care of her mother and grandparents. Especially the latter. Everything’s changed. Well, you know something about that, Mabel – look at poor Harry Drover, the way his life’s been destroyed.’

  ‘Don’t say that,’ she said sharply.

  ‘I’m sorry, Mabel, but I’m tired of pretending. Listen, I couldn’t have done that bloody tracheotomy without you, I was half paralysed with terror in case I killed her. I need you, can’t you see, can’t you understand? Oh, for God’s sake, girl, don’t turn away from me, I can’t carry on without you. Mabel, help me!’

  He had seized her shoulders and was almost shaking her as he spoke in a tone that was both angry and imploring. ‘You listened to me when I told you what I’d done out in France. It made you a part of me, more than anybody else I’ve known. I can’t tell you what it meant –’ He broke off and stood before her, his eyes fixed on hers so that she could not look away. ‘Mabel, please, just for the duration of this bloody war, I’m begging you, my dear, my darling – I’m lost, I need you – help me, for Christ’s sake.’

  She was never sure of what exactly happened next. With his back against the kitchen door his arms were round her, holding her with fierce possession. She put up her hands to fend him off, but her arms seemed to lift of their own accord, resting on his shoulders and then sliding up around his neck until her hands met at the back of his head.

  ‘Mabel, Mabel –’

  She opened her mouth to speak, but his lips closed upon hers, taking her breath away. Unable to speak or move, she clung to him, swaying in his arms, his mouth fastened to hers in a hungry kiss, a selfish kiss that had no thought for anything else but his own overwhelming need. His hands roved over her back, one holding her shoulders, the other tracing the downward curve of her spine and coming to rest on her buttocks, pulling her thighs against his hardness. She felt her body soften, seeming to melt in the heat of his desire. It was an indescribable sensation.