Yes Sister, No Sister

by Jennifer Craig

  Her mother died when Sandy was 12. After that she was expected to, and did, run the house for her father and two older brothers. Only when the brothers left home was she allowed to contemplate a career for herself. Her days off are to be spent cleaning the house and leaving a week’s meals ready for her father, as these are the conditions under which she was allowed to leave home.

  After dinner and a walk around the grounds, we have the first of many lectures. It is firmly implanted into us that the control of disease and the way to health lies through clean water, treatment of sewerage, hygiene and fresh air. The first hygiene lecture includes personal hygiene, which Down approaches head-on with little or no regard for our sensibilities. We are told that we are to bathe daily with particular attention to our underarms.

  ‘Patients are sick enough without having to smell a nurse’s armpits as she bends over them,’ Down says. ‘You must constantly check that you do not smell and if any of you realise that one of your colleagues smells, you must inform her. It is difficult to smell your own breath so you must ask a colleague to check for you.’

  From then on we exhale vigorously at each other to do the breath test and begin a life-long habit of surreptitiously sniffing our armpits.

  I go out for a day with a district nurse and see for myself the appalling conditions in which some people live. I have seen abject poverty in India but I did not realise it is also prevalent in my own country. Many people live in ‘one-up one-downs’, as the rows of small houses built in the Industrial Revolution are called. They are literally two rooms, one on top of the other. There are no bathrooms. Six houses share an outside toilet and each house has one cold-water tap. Despite the lack of running hot water the steps of most of the houses are well scrubbed and the lace curtains at the windows gleam white against the grimy brick walls. All except for the one house that we enter.

  The district nurse knocks on the door and I can hear shuffling inside. Finally the door opens.

  ‘Coom in, coom in,’ an old man says.

  After we step straight from the pavement into the living room, I am met by an unpleasant rancid smell. When my eyes are accustomed to the dim light, I see a large, square table that takes up most of the space. On it stands a medley of unwashed empty milk bottles, chipped mugs, dirty plates precariously balanced on each other, greasy cutlery, a box of sugar cubes, a stale loaf, several slices of old toast and a collection of tins.

  A coal fire burns in the hearth beneath a cluttered mantelpiece. Drawn up to this is a plush-covered easy chair with a cushion holding down the protruding springs. Under the window, a stone sink with one leaking tap has a wooden draining board covered with more dirty dishes. In the sink, a pan, containing what looks like burnt porridge, is filled with greasy water and the plop, plop of water dripping into it is an irritating background sound.

  Against one wall stands a cabinet with a crocheted runner covering its uncluttered surface. On it sits a framed photograph of a woman wearing a fur collar and a cloche hat of the 1920s.

  ‘Good morning, Mr Harrop,’ the district nurse says. ‘This is a student nurse from the Infirmary who is spending the day with me. How are you?’

  ‘Nicely, thank you,’ says the old man. He has been tall but is now lean and bent. He wears a collarless shirt, a stained grey woollen cardigan and pyjama bottoms. ‘Would you like a cuppa?’

  I am relieved to hear the district nurse say, ‘No thank you, Mr Harrop. We’re running a bit late today. How’s your leg?’

  He sits on the easy chair, extends one leg and rolls up the pyjamas to uncover a bandage around his calf. The district nurse kneels down to unroll the bandage and I promptly feel sick when a huge ulcer, taking up most of his calf, is revealed.

  ‘It’s looking a wee bit better,’ she says. ‘There’s signs of granulation down this edge, look.’

  Looking better? How much worse can it be than this? I stare at the cavernous wound. It looks as if an animal has taken a bite out of him and then sprayed it with green pus. The district nurse pulls a dressing tray out of her bag. She washes her hands with her own soap and dries them on her own towel. Then she throws the old dressing on the fire before starting to clean the ulcer. I can hardly look. Will I ever be able to attend such a horrible wound without vomiting? My image of myself efficiently changing dressings quickly vanishes. Instead I see a dithering twerp who has to swallow hard and smile through clenched teeth.

  Desperately needing something to do or say, I pick up the photo of the young woman and say, ‘Was this your wife? She was very beautiful.’

  ‘Ay, she were that. Allus was, even to the end. I never fancied another woman, only her. She died three year since.’ Mr Harrop takes the photograph from me and strokes the glass. ‘I still miss her. T’house wouldn’t be this mess if she was here.’

  ‘When is your niece coming again, Mr Harrop?’ the district nurse asks.

  ‘She couldn’t come last week but she should be here today. She’ll clean up and bring me some bread and tea. I’ll be alright.’

  ‘I’m a bit worried that you’re not eating properly,’ the district nurse says as she packs her bag.

  ‘Oh, I’m alright. Neighbour brings me a Sunday dinner and my niece will bring me some fish’n’chips and mushy peas. Tha’ don’t need much to eat at my age.’

  We leave and as we retrieve our bicycles I say, ‘That’s terrible. How can we leave an old man like that? He should be in a home.’

  The district nurse is attaching her bag to her pannier when she looks at me and says, ‘What makes you think he would he better off in a home?’

  ‘Well, he’d get regular meals for one thing and he wouldn’t be so dirty. His clothes are filthy and did you see the state of the sink and dishes? It was disgusting!’

  ‘You’re making a lot of judgements about how people should live. The most valuable thing for old people is their independence and that’s what he has. Does it really matter if his clothes and house are dirty? Does it?’ She stops to look straight at me with her clear grey eyes.

  I don’t know how to answer. We have just had lectures on hygiene and here is a nurse who does not seem to think it matters. I had seen filth in India, but nevertheless, people did cope and even seemed cheerful. But I still don’t think we should just walk away from an old man who cannot look after himself.

  ‘The most important thing for you to learn, lass, is to stop thinking you can change the world. Nurses can only do so much. If Mr Harrop wants to go into a home, I will arrange it, but he doesn’t.’

  My mentor mounts her bike and as we pedal off she says, ‘When you get dirty patients coming into the hospital, remember they often have only cold water and no proper bathrooms. It’s a wonder they manage at all.’

  I will appreciate the difficulties people live under, and I will value independence, but I will not stop thinking I can change the world because I know I can.

  Chapter 3

  THE WARD IS like a cathedral with immensely high ceilings. Tall windows, wanting only stained glass to support the illusion, rise up to finish in an arch. Rows of beds, each with a white counterpane, stretch to infinity down either side. An untidy line down the centre of the ward consists of Sister’s desk first, followed by a sink, oxygen tanks, a medicine cabinet on wheels, an emergency trolley, easy chairs, and eventually, a long wooden table covered with vases of yellow and rust chrysanthemums. Beyond that is a low built-in set of cupboards topped with a work surface.

  ‘Come along Nurse Ross, don’t stand there gawking!’ Sister Downes says as we first enter Ward 21. I feel like a newborn lamb that first confronts the enormity of a moor.

  ‘Sister Curtis, this is Nurse Ross who will be here until 6pm. She is to go to first supper and is then off duty.’ Down leaves me to my fate.

  Sister Curtis is an immense woman who seems truly formidable in her sister’s uniform. Her appearance is deceptive however, for she has a gentle voice and her first words are ‘Yes, the first sight of a ward is overwhelming. It will shrin
k in time.’ She leads me to her desk. ‘I’m glad you’re here as you can be very useful to us. Perhaps you can begin by taking these TPRs for me.’ She writes eight bed numbers on a piece of paper. I must be looking blank as she says, ‘You know, temperature, pulse and respirations. The thermometer tray is on the cabinet at the end of the ward. Have you been shown how to chart TPRs?’

  ‘Yes Sister.’

  I try not to draw attention to myself by letting my feet clop on the polished wooden floor but I am sure all eyes are on me. I wonder if my stocking seams are straight. I hope a patient won’t call me. A man does call out but to his neighbour. ‘Jack, has tha’ got a pencil?’ His neighbour nods. ‘Nurse, can you pass t’pencil this way?’ Thank goodness for a request I can readily meet. ‘Thanks luv,’ he says as I hand him the unpainted wooden pencil.

  The thermometer tray lies on the cabinet as promised and I am relieved to see that it looks just like the one in PTS. Bed eight is the first on the list. The occupant is asleep. Not wanting to wake him up, I move to the next on the list. This time a pair of suspicious eyes glare at me from a sallow, drawn face.

  ‘Just going to take your temperature, Mr Greenside,’ I say, noting his name on the temperature chart that hangs above his bed. Glass thermometers rest in a container of pink fluid in a tray holding cotton wool balls. I wipe one and attempt to shake it down with that flick of the wrist expert nurses have mastered but I have not. My shakings are to no avail: the mercury remains where it is at 99 degrees. Frustrated, I use my whole arm but even this windmill approach will not shift the mercury. I look for another thermometer and am relieved to find one registering 96 degrees.

  ‘Can you put this under your tongue please.’ Mr Greenside’s toothless mouth opens for me to place the thermometer under his tongue. My pocket watch is ready, his wrist is held out, but he has no pulse! In a panic, I feel around his thin, bony wrist, pressing gently on various parts, but there is no pulse. My first task, a simple one of counting a pulse and I can’t do it. Any remaining images of competence vanish.

  I try the other wrist. Oh joy – there is a pulse. I carefully count it for a full minute and then surreptitiously count his respirations. We had been told not to let patients see us counting respirations because if they do, they tend to breathe differently. After taking the thermometer out of his mouth, I read it and replace it in the container. I record the numbers on the temperature chart as we had been shown, making neat dots on the appropriate graph line, joining them to previous dots with a straight line, not a curved line. ‘Some nurses get sloppy and use curved lines, which do not give a true picture of the variations in TPR, and this PTS is not going to be sloppy, is it?’ echoes in my mind.

  After 45 minutes I take my list of the eight TPRs to Sister Curtis. She receives it graciously and thanks me as though I have performed some special service. She refrains from telling me that the average time for taking TPRs on the entire ward of 34 patients is 30 minutes.

  ‘Now perhaps you can help Nurse Watkins with the teas.’

  Watkins is wheeling round a trolley of cups and saucers and a giant metal teapot. ‘Oh good,’ she says when I come up to her, ‘you can do the feeds. Go to everyone with a feeding cup and help them drink their tea. Be careful it’s not too hot for them.’

  I find the first bed with a white china feeding cup, a bowl-like vessel with a curved spout like a teapot, and stand holding it to the patient’s lips.

  Watkins comes over and hisses, ‘You have to sit down to feed patients. Makes them think you aren’t hurrying them. Only time you’re allowed to sit down!’

  Sitting holding cups to lips gives me a chance to look around. The influence of Florence Nightingale, who designed these wards, accounts for the high ceilings and tall windows. Because of her emphasis on fresh air, each patient is allocated a certain cubic footage of space. Despite it being an open ward, each patient has considerable privacy. From my position at the head of a bed I cannot see the adjacent beds because of the bunch of drawn back curtains, and the beds opposite are so far away I need binoculars to see them. Besides, all the paraphernalia in the centre of the ward obstructs the view.

  I can see the comings and goings of the nurses, which means that a patient has a nurse in view at all times but, more importantly, the nurses can see the patients as they walk up and down. Sister Uprichard’s words come back to me: ‘Wards should never be without a nurse in sight. If you go out of the ward, into the sluice room for example, you are to ensure that there is another nurse on the ward before doing so.’

  It is remarkably quiet given the presence of so many people. There is the occasional cough and the murmur of distant voices but the general atmosphere is one of drowsiness, particularly as it is the afternoon and treatments, physician’s visits and various tests have been done. A warm stuffiness adds to the drowsy feeling as, despite the many windows, they are all firmly closed. I am almost too warm, even in my cotton dress, but I notice that many patients have their bedclothes drawn up to their chins. Some even hug a ‘chest blanket’ as we call the small blankets used for covering body parts during procedures and bed baths.

  Sister Curtis is making notes in a book she carries as she talks to some of the patients. Her dress is a pretty blue with long sleeves that usually end in solid, white removable cuffs, but now she has the sleeves rolled up and secured with soft, white, voile cuffs. I wonder what I will look like in one. Her apron is the same as mine but the bonnet she wears is a mass of starched white frill that looks more like a bridal bouquet than a nurse’s uniform.

  I have to feed a patient in an oxygen tent but I am baffled about how to gain entry. These tents are made of a sort of perspex, which hang from a frame to envelop the patient and the head of the bed. A man-sized, green-painted oxygen cylinder, with a dial and a handle like those in submarines, delivers oxygen into the canopy. A ‘No Smoking’ sign dangles from it. The tent is firmly tucked into the bed all around, secured by a folded sheet across the patient’s hips. Am I supposed to remove the sheet? Eventually I notice a large zip running across the front that I undo to reach the patient.

  He is a large, florid man with red cheeks and bluish lips. ‘Your tea is here,’ I say, holding the feeding cup to his lips. He takes one sip, coughs, chokes and gasps for air. Oh my god, I’ve choked him. I can feel sweat break out on my forehead. What do I do? I stand dithering until Sister Curtis comes over, leans the man forward, takes an oxygen mask that is hanging from the cylinder and places it over his face. He gradually returns to normal.

  ‘Don’t worry, Nurse Ross,’ Sister says. ‘Just carry on with the others.’ I feel too nervous to feed anyone else. Surely feeding people is a task anyone can do without choking them? I want the floor to swallow me up until it’s time to go.

  Watkins and I collect the dirty cups and saucers that we leave in the kitchen for the orderly to wash. I want to know what it is like to drink out of a feeding cup so I grab an opportunity to go into the kitchen, pour some tea into a clean feeding cup, and hide behind the door to drink. The tea tastes like it does when it’s been in a thermos and I don’t like the sensation of a stream of fluid being poured into me without my control.

  Next is a bottle round. Wearing pink gowns over our uniforms, Watkins and I offer glass urinals from a crate to all the men who are bedridden. After a few minutes we collect the full ones. Watkins shows me how to measure the urine of the bottles on Intake and Output and record the amount on the I & O chart.

  ‘Once in a while you get a dirty old man who wants you to put his thingy into the bottle for him. When that happens, use a pair of rat-toothed forceps. He won’t ask again!’ With this sage advice we go for tea.

  When we return we prepare for the patients’ supper. ‘You have to watch Kitchen,’ Watkins says as she plugs in the large, wheeled, metal canteen and starts stacking plates in it. ‘They’ll be here soon to bring the hot containers but if it’s Walls’ ice-cream for pudding, they put it in the hot canteen too and then it drips all over the floor.’<
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  Pointing to a wide staircase with a wrought iron handrail on one side of the foyer I ask, ‘What’s up there?’

  ‘Ward 22, the female medical ward,’ Watkins says. ‘Most of the wards in the old part have the men’s and women’s wards together so the consultants don’t have to walk far.’

  We set all the bed tables with cutlery, find each patient’s serviette and fill up the water glasses. Finally, as time for supper draws near, we go round to sit everyone up. Some patients prefer to sit at the big table in the centre so we clear the flowers onto the work table, set places for them and help them out of bed if necessary. Just as supper is to be served by Sister, it is time for me to go. I ask to be excused. She says, ‘Thank you so much, nurse, you have been a great help. I look forward to seeing you next week.’

  I practically skip to the dining room. I have actually looked after patients. I am a real nurse.

  As she cuts up a sausage, Sandy greets me with, ‘Well, did you kill anyone?’

  ‘Don’t talk like that,’ Judith says, eyeing a forkful of cabbage suspiciously. ‘The chances of killing a patient are nil and all that stupid Thornton woman has done is make us nervous. How did you get on, Jen?’

  ‘Alright. Except I had to take eight TPRs and it took me 45 minutes. Sister didn’t say anything though. How did you get on?’

  ‘Guess what ward I’m on?’ Judith rolls her eyes. ‘Orthopaedics!’

  ‘Just the experience you need. Is it anything like before?’

  ‘Not really. Mostly fractures and surgeries, not congenital deformities. But anyway, all I did was help with teas and supper plates and do a bedpan round.’

  Sandy is listening intently. She hasn’t been on a ward yet. ‘Tell me what it was like? Were you scared? What did you do?’

  ‘I was scared when I first went on,’ I say. ‘The ward seemed to stretch for ever and ever.’ I explain to her that I’d had to walk to the far end of the ward to get the thermometers and how I feared that a patient would call me. ‘Working with someone else wasn’t so bad, but I still felt silly walking up and down in front of all the patients.’