Yes Sister, No Sister

by Jennifer Craig

  I am nervous but excited. My first injection! We go to the bed and I draw the curtains and the patient obligingly gets ready, as he knows what to expect. He is certainly an enormous man with a huge bottom. I swab the skin and aim the syringe. Not quite hard enough, but it goes in and I push down the plunger. As the fluid is so dense, I have to push really hard. I withdraw the needle and swab the area again, giving it a good rub to help the penicillin disperse into the tissues.

  ‘Didn’t feel a thing, nurse,’ the patient says. He gives me a wink. I am sure he knows I have not done it before. I pull the curtains back and Sister Curtis and I go back to the sterilising room to wash the syringe and needle before putting them in the steriliser.

  ‘Well done, Nurse Ross. I must make sure that you have many opportunities to do this again before you go on nights as you will have to give lots of injections then. I must also see that you have the chance to give some subcutaneous injections too. If you have your GNC record here I will sign it.’

  State registration requirements include three years training in an accredited training school, a Preliminary Examination after one year, a Final Examination and completion of a Record of Practical Instruction and Experience for the Certificate of General Nursing. Sister Curtis is referring to the latter.

  I produce my plain, brown cardboard-bound booklet for Sister Curtis to mark one stroke in the appropriate column to signify that I have been instructed in the giving of injections. A cross will indicate that I am proficient. Curtis tells me to show her my record before I change wards so that she can fill in other columns.

  I go back to wiping lockers feeling that I am, at last, getting somewhere. The next day I give a subcutaneous injection of morphia. To prepare it, I am shown how to light a spirit lamp and place a tablet of morphia in 1.5cc of water in a teaspoon, which I then hold over the flame until the tablet dissolves.

  ‘This tablet is a quarter of a grain,’ Sister Curtis says, ‘and it is dissolved in 1.5cc of water. So how many ccs will you need to give a sixth of a grain, which is what this man needs?’

  I take a piece of paper out of my pocket and write out the calculation. ‘One cc,’ I say.

  ‘Yes, that’s right. Morphia is listed under the Dangerous Drug Act, or DDA, and these drugs are kept in this locked cupboard, and I, or whoever is in charge, must carry the key on our person.’ She pulls a bunch of keys out of her pocket to show me the DDA cupboard key. ‘Now I will watch you give it to him.’

  I inject the morphia into the patient’s upper arm and he receives it with a sigh of relief. Curtis shows me how to record the narcotic in the DDA register and how to record it, in red ink, on the patient’s chart.

  ‘These drugs are addictive so we must be careful how often they are given. But do use some common sense! If someone is dying it doesn’t really matter if they become addicted to narcotics – it’s more important that they’re free of pain.’

  When I compare notes with my friends, I am the only one to have given both types of injection so far. I strut around the room until someone throws a pillow at me.

  We spend a lot of time grumbling about the Sod. She has the habit of going into our rooms and stripping our beds if she thinks they are not made properly.

  ‘Look at this!’ Judith says when she opens her door after coming off duty. ‘That bloody woman’s been in and stripped my bed again. In future I’m just leaving it as what’s the point of making it twice. And it’s none of her damned business how I leave my bed anyway.’

  ‘And to think she goes to Mass every day,’ says Marie who happens to pass by.

  ‘Fat lot of good it does her,’ Judith says.

  ‘Ah, but think how much worse she’d be if she didn’t go,’ Marie says.

  Can she be developing a sense of humour?

  One evening, after nine o’clock, when most of us are in the Nurses’ Home, there is a fire drill. The Sod had warned us this would happen and told us to read the instructions, but, of course, none of us but Marie had done so. Fortunately, Marie is in and tells us we are to check the rooms on either side of us, gather in the passage and then leave the building.

  Most of us are in pyjamas and dressing gowns as we wait outside. The Sod comes out with a list and we are to answer ‘Here’ when our name is called. She goes through the names.

  ‘Narrse Talbot.’ Silence. Again, ‘Narrse Talbot. Has anyone seen Narrse Talbot?’

  ‘Yes Sister, I walked over with her when we came off duty,’ Sandy says.

  The Sod finishes the list and says, ‘Everyone stay here except Narrse Ross and Narrse Chart. Come with me.’ Marie and I follow the Sod as she runs up to our corridor. ‘Ye two take a side each and I will look in the bathrooms.’

  I run down one side, opening doors and looking in rooms as Marie runs down the other. We reach the end of the corridor in time to hear the Sod saying, ‘Narrse Talbot, what in the name o’ mercy arre ye doing lying in a bath during fire drill?’

  I cringe for her as Wee Jess says, ‘I thought that being in water ith the thafest place to he during a fire, Thister.’

  My first death occurs one evening during visiting hours. I am alone on the ward with another peak. Madson is serving a second term of probation as she has not measured up to the mysterious, unexplained expectations we are to meet in order to get our permanent caps and move out of probation. I find the patient in bed 20 looking faintly green and not breathing. Madson comes over.

  ‘I think he’s dead,’ I whisper. We gaze at him in horror, not having the first idea what to do. I recall, from some movie, that one is supposed to close the eyes with a cupped hand, but this man’s are already closed.

  Both the perms, thinking the ward was quiet and with nothing to do during visiting time, had gone to supper at the same time. ‘Put screens round him,’ I say to Madson, ‘and I’ll run to the dining room.’

  The dining room is a long way from the ward. I forget such directions as ‘Always walk in a stately manner’ as I pelt along the main corridor. Breathless, I hurl myself into the staff nurses’ section of the dining room and search the surprised faces for one of my staff nurses. I don’t have to look for long as they see me, and the three of us hurry back to the ward.

  The staff nurses lay out the body but they do not volunteer to show either Madson or me how to do this. I think they feel guilty about leaving us alone but they don’t ask us anything about the experience or reassure us that we had done the right thing. I feel shaken and guilty. Was there something we could have done? Perhaps the man would be alive if I was more competent.

  I miserably go off duty and find Judith to tell her about the incident.

  ‘There’s nothing you could have done, Jen. He was dead when you found him, wasn’t he? At least you realised that he was dead and went for help. And you pulled the screens around so visitors couldn’t see. What more could you have done?’

  ‘I don’t know,’ I say. ‘That’s just it.’

  ‘Look, you’ve been in the hospital for four weeks – how can you be expected to know what to do? The staff nurses should never have gone to supper together and left two peaks alone.’

  ‘He died peacefully, that’s a blessing,’ I say, feeling comforted. ‘I expected death to be revolting, but it wasn’t. In fact he looked just the same except for the greenish colour and not breathing. Next time I won’t be so scared.’

  Chapter 8

  ALTHOUGH WE ARE supposed to peak for three months, our set is put on night duty after only six weeks. I report for duty at 9pm on a male orthopaedic ward with a third-year nurse called Collins. After the report from the day sister, I am to go around with a trolley of hot drinks. ‘What would you like?’ I ask the patient in the first bed.

  ‘What have you got?’ he returns.

  ‘Hot milk, cold milk, Horlicks, Ovaltine or tea,’ I recite.

  ‘Horlicks please,’ he says.

  Damn – Horlicks takes forever to mix, but I spoon some into a beaker, mix it with cold water, add hot milk and move the
trolley three feet to the end of the next bed. ‘What would you like?’ I ask.

  ‘What have you got?’ comes the reply.

  ‘Hot milk, cold milk, Horlicks, Ovaltine or tea,’ I chant again.

  ‘Tea, please.’

  At the next bed I have learned and ask the patient, ‘Would you like hot milk, cold milk, Horlicks, Ovaltine or tea?’

  Many of the patients are young men with fractured femurs who lie on their backs with the broken leg resting in a Thomas’s splint suspended from a Balkan frame. These splints resemble metal tomato plant holders with the bigger circle padded with leather. The extended metal rods, when fitted with a cloth, act as a sling for the leg. Tapes running down each side of the leg finish in cords that wind through pulleys in the Balkan frame to support a hanging weight. Thus both support and traction are achieved.

  All the young men are together at one end of the ward and the legs in the splints look like an army with legs raised in a Nazi salute. As they feel well, but have to lie in more or less one position for six weeks, they become extremely bored. A new nurse is just what they need to liven up their day.

  ‘Come and ’ave a look at this nurse,’ one says as I go round with the drinks, ‘it needs some attention.’

  I innocently go to his bed as he lifts up the top sheet. Howls of laughter from all round as all the young men lift up their sheets and say, ‘Come an’ look at mine too.’

  I dread the bottle round but having learned from Watkins, I go into the sterilising room and put a pair of rattoothed forceps in my pocket. Sure enough, one of the young men lies back weakly and groans, ‘I can’t manage, nurse, you’ll have to put it in for me.’

  ‘Certainly,’ I say, and approach with the forceps held menacingly.

  He cringes. ‘No, no, I can manage after all. My strength has returned.’ No one else tries the same trick.

  Collins and I do beds and backs to get everyone settled for the night. These patients not only need back care but we have to lubricate the ring of the Thomas’s splints with Vaseline or else the leather becomes hard and cuts into the skin. It is like being in a stable and looking after the tack.

  One young man, Tom, has been there for nearly three months with a fracture that refuses to heal. After several operations he is now in a cast from groin to ankle.

  ‘Lift your bottom up,’ I order and he hoists himself by holding onto his pull bar so I can give the sacral area a good rub.

  ‘Give us a goodnight kiss, nurse,’ he says, puckering up his mouth.

  ‘How do I know if you’ve been a good boy?’ I respond.

  ‘Oh, I have, I have. Even Sister says I’m a good boy.’

  I look at his head sheet then say, ‘Sorry, it says here that goodnight kisses are forbidden.’

  The night sister comes to give out the o.n. drugs (sleeping pills) with the charge nurse and I follow behind them. After they check the medicine and the dose between them they leave the pill in a teaspoon. I then help the patient swallow it.

  Eventually the ward settles down and the lights are turned out. In the dim glow of a few night-lights the ward looks even more like a cathedral as vast, dark shadows replace the uniformity of the rows of beds. When at midnight Collins goes for dinner, I am left alone. I am thrilled! I am in charge of all these sleeping forms, ready to minister to their every need. It doesn’t occur to me that if anything goes wrong, I have no idea what to do. I pick up a torch and walk quietly round the ward feeling immensely important – all these men look to me for succour and … the entrance of the night sister breaks my reverie.

  ‘I will do a round, Nurse Ross,’ she says.

  We go to the first bed. She looks at me expectantly. I don’t know what to say. ‘Who is this patient?’ she finally asks.

  ‘I don’t know,’ I reply.

  ‘Didn’t you take report?’

  ‘Yes Sister.’

  ‘Nurse Ross, when you do a round with a night sister, you are to know every patient’s name, their religion, their diagnosis and their investigations and treatment. As this is your first night, I will say no more, but tomorrow night, I shall expect a proper round.’ She walks round while I trail miserably behind her.

  When Collins comes back, she sees my panic and wants to know what has happened. She thinks one of the patients must have collapsed but when I tell her that Sister has visited and I am to know all 32 names, diagnoses and treatments by tomorrow, she says, ‘Oh is that all! The sisters do that to all the new first-year nurses. Don’t worry; we’ll make a list out when you come back from dinner. You’ll soon learn it.’

  ‘But I’ll never learn all that by tomorrow night and she says she’ll be back tomorrow to do a round.’

  ‘She won’t. She’s off and Busby is back. She’s our regular night sister.’

  ‘What’s she like?’

  ‘Oh, she’s OK. Used to be in the QAs (Queen Alexandra’s Royal Army Nursing Corps) and knows how to talk to these men. They practically salute when she comes round. You’d better go for dinner.’

  Thus began the training for quick memorisation of a ward full of patients and I understand why Up and Down learned our names so quickly. At first we can hardly say some of the diagnoses, especially the surgical ones such as gastro-jejunostomy. We have no idea what Addison’s Disease is or what CHF (Congestive Heart Failure) stands for, but we soon learn. Until now, the patients have been bodies that need to be fed, watered and bedpanned but on nights they become people with things wrong with them that we have to know about.

  The first night wears on. One of my duties is to pack the drums with dressings I have made. From rolls of cotton wool I make small balls, and from rolls of gauze I cut and fold strips into squares. Then I stuff the drums. Drums are round metal containers that actually do resemble drums. Circling the side is a sliding metal plate, which, in one position covers holes in the drum, and in another, leaves the holes open. When they are filled with dressings I put the drums out to be autoclaved. Before being put in the auto-clave, the holes are open and when the drums are ‘cooked’, so to speak, the holes are covered with the sliding plate.

  I also clean and boil syringes in the steriliser, make sure the needles are not blocked, wash down the trolleys with carbolic and collect the urines to be tested by the day staff. In the kitchen, I have to set the trolley for the day staff to give out the breakfast cutlery, put on an enormous pot of porridge, make sure it doesn’t burn, cut mounds of bread and butter and cover them with damp cloths. In between these tasks, we go round turning patients who have to be turned frequently, give out urinals, make sleepless patients a warm drink, and do the various treatments that need to be done.

  Around three o’clock I am dying to go to bed. I have to struggle to keep my eyes open and my body feels so heavy, I can hardly move. All I want to do is lie down and go to sleep. At four o’clock I go for tea and find the rest of my set in the same condition.

  ‘Oh God, I’m never going to survive this,’ Sandy says, laying her head on the table. ‘Come and get me in the morning.’

  ‘I had no idea this was going to be so awful,’ says Marie who is on a female medical ward. ‘I thought nights would be quiet and that we can sit down and take it easy but so far I’ve been rushed off my feet. Half the patients have gone dotty and keep calling out for a dead relative or something. If they’re not incontinent, they want a bedpan all the time.’

  Judith says, ‘Be a nurse – a distinguished career for women!’

  Only Blinks seems to be wide-awake. She is on a children’s ward.

  ‘My patients sleep OK,’ she says. ‘In fact they were fast asleep when we went on. There isn’t much to do except clean things. But there is one poor little thing with steatorrhoea and we have to collect all his stool, and seeing that he has constant diarrhoea, it’s not easy.’

  ‘What’s steatorrhoea?’

  ‘It’s when they can’t absorb fat so it all comes out in the stool and makes it white. We have to keep him on a sort of frame to raise his bottom so
he doesn’t sit in it.’

  ‘Do you have many babies?’

  ‘No, they’re nursed on Princess Mary ward. Babies up to a year go there then we have them until they’re 14.’

  ‘I don’t want to go on a children’s ward very much. I don’t know how to talk to them,’ I say.

  ‘Oh, they’re easy to talk to. I love children. Not that we have much chance to talk to them in the night but I’m looking forward to six when they wake up.’

  I can imagine that Blinks is really good with children. She would be sweet but firm with them and remain unruffled no matter what they did.

  I get a second wind about five o’clock and anyway, we are so busy that I forget how I feel. Before the ward sister comes on we have to bedbath the sickest patients, do a bottle round, hand out wash bowls to everyone, collect them, give out cups of tea, take everyone’s temperature, pulse and respiration, give out medicines, do dressings and other treatments, and deal with any unexpected event. In addition, there are always the two hourly turns, patients to feed with drinks and mouths to clean, all of which are a constant throughout the 24 hours.

  Compared to the day staff that arrive at 7.30 looking fresh with sleep and with clean aprons, Collins and I present a worn, bedraggled appearance. Sister and the perms come on at eight and, after prayers, I am free to go while Collins has to stay to give report. To the dining room for breakfast, then a bath, then at last, fall into bed. One of my aunts told me how nice it must be to be on nights, as I would have all day to do things in. She didn’t seem to realise that we still need a good eight hours sleep and that night duty does not entail sitting reading or knitting. In fact, it is 11 hours of hard labour relieved only by two half-hour breaks.

  One night my ward is very quiet and Sister Busby, our regular night sister, comes in to tell Collins that she is borrowing me for Ward 12 as they are very busy with a death.

  ‘Have you laid anyone out before?’ she asks.