‘No Sister.’
‘Well, I will help you and you will see that it is not too bad.’ Such concern is rare in sisters. ‘It is your last service for your patient. Always treat a body with the same respect you gave when it was alive.’
‘Yes Sister.’
Busby rolls up her sleeves and together we wash the body and comb the hair. The body feels cold and as we roll it from side to side I can see the skin is blue and mottled. Busby still covers the part of the body that we are not washing, to preserve modesty, in the same way we do with live patients.
We pack the rectum with tow, tie the big toes together, put on a clean nightie and finally try to tie up the jaw with a piece of gauze bandage. There is a slit in it for the chin and the other ends are knotted above the head.
Busby says, ‘This is an inadequate way of keeping the chin up but we do it anyway. To send a body to the morgue without the traditional gauze bandage around the head is sure to bring trouble from the mortuary attendants.’ She rolls her eyes. ‘To question the ritual will bring even more.’
I’m amazed that she talks to me like, well, like a colleague. Finally we attach a name-tag to the toe bandage, wrap the body in a clean sheet and slide it on to a trolley. An orderly from the morgue comes to fetch it as we close the curtains round all the beds in the vain hope of concealing the death from the other patients.
Not everyone in my set is introduced to death as gently as I was. Jean Smith was on the neurosurgical ward. They admitted a young man who had flown off his motor bike and was virtually dead on arrival. His head injuries were so terrible that brain tissue was oozing out of the numerous lacerations. He was declared dead as soon as the houseman arrived, then Jean had to lay him out. She and the senior nurse attempted to pack the wounds as best as they could but the oozing continued. In the morgue, the attendant complained about the discharge to the night sister, who went straight to the ward to tell off the nurses.
‘The way you laid out that patient was simply awful; his head wrappings are soaked already. Nurse Smith, take some fresh packing, go to the morgue and re-pack the head’.
Jean Smith, 18 years old, picked up the dressings and left the ward, but instead of going to a morgue in the middle of the night, went to her room, and instead of packing a dead man’s head, she packed her suitcase and left for home. She was the seventh in our set of 33 to do so.
Chapter 9
SISTER BUSBY IS tall and dark. If she had been a man, she would have had a moustache, worn tweeds and been addressed as ‘Major’. She holds herself erect as she walks round the ward, with her hands behind her back. Her hospital badge holds up the bib of her apron on one side, and a bar of military ribbons the other. She is older than the other night sisters as they are only doing nights until a ward comes free and they can become a ward sister. Busby, however, has chosen to be on nights permanently.
I am rubbing a patient’s back when he tells me that she had been in France, had escaped at Dunkirk and then was in North Africa.
‘How do you know that?’ I ask him.
‘Coz I was there too and she told me one night. You can tell from t’ribbons any road. She got the MBE tha’ knows.’
‘What’s that?’
‘Member of the British Empire. It’s the medal given to nurses for gallantry as they weren’t eligible for the DSO.’
‘What did she get it for?’
‘I don’t know – she wouldn’t tell me. But she’s a grand lass tha’ knows.’
She is a ‘grand lass’ and I adore her. I never did find out what she did to earn the MBE but I did learn that 12,000 State Registered Nurses served in the war and 235 were killed in action. Although our training often focuses on tradition, we are never informed of the part that nurses played in the war, nor indeed is the general public.
After a few nights Busby asks to do a round with me. ‘You can use your list if you like, Nurse Ross. I know how hard it is to remember everything at first.’
We stand at the bottom of the first bed. I say in a low voice, ‘Mr Headingly, age 42, repair of comminuted fracture of radius and ulna, fourth day. He’s up and about and due to go home when his stitches come out.’
‘What does “comminuted” mean?’ Busby asks.
‘It means the bone broke into fragments so that just putting on a splint won’t heal it. The fragments have to be put back into place.’
‘Why does he have a splint on rather than a cast?’
‘Well, he’s got stitches in so I expect it’s so they can be taken out and the wound dressed.’
‘Yes. So he’s got a splint held on with an elastic bandage. What do you have to watch out for?’
‘That the bandage isn’t too tight.’
‘Yes, that it wasn’t put on too tight but also so that his arm doesn’t swell so the bandage becomes too tight. So what do you check?’
I think for a moment. ‘That his fingers aren’t blue or swollen and that they are warm and that he can feel me touching them.’
‘Very good. Suppose you do find his fingers swollen, cold and insensitive to touch, what would you do?’
‘Tell Collins or call you.’
Busby laughs. ‘Suppose we’re not here and you have to make a decision, what would you do?’ She seems to be enjoying herself. So am I.
‘I would take off the bandage being careful to leave the arm in the splint, and examine the wound. Then I would put the bandage back on more loosely and check his hand frequently. I would also make sure his arm is elevated on a pillow.’
‘Good. Now, what would be the signs of an infected wound?’
‘Redness, swelling, hot to the touch and a purulent discharge.’
‘What would you do if the wound was like that?’
‘If you or Collins weren’t here I would notify the houseman.’
‘Before you notified anyone, what else would you do?’ I shake my head. ‘You would take his temperature, wouldn’t you? Now when we next do a round, I want you to be able to explain to me why the temperature rises when there’s an infection.’
We move round the ward in a similar way – Busby asking questions and me trying to answer them. It is clear that she is trying to teach, not humiliate, and I feel so stimulated when she has finished that the menial tasks do not seem so boring. When I’m a sister, I’m going to teach like she does.
As I become confident about the names and diagnoses, she will start the round at the last bed on the ward and go backwards, to make sure I really know the patients. One night she starts walking round and suddenly stops at one bed to ask, ‘Who’s that?’ I don’t know, but I make up a name and diagnosis and say them with assurance. Our eyes meet. I know she knows I am bluffing but she doesn’t say anything.
Just after we come on one night, Collins sends for her because a new patient is in considerable pain. He has a fractured femur and numerous cuts and bruises after a fall down a quarry on his bike. His leg is in a Thomas’s splint. When Busby arrives she asks who put it on.
‘I think the houseman did, Sister,’ Collins says.
‘It is not the right size nor are the cords wound through the pulleys correctly,’ Busby says. ‘Let’s give him some morphia and I will find a more suitable splint. Do you have a tape measure?’
She measures the good leg and the width of the thigh at the groin. She leaves, to return 20 minutes later with two splints she has ferreted out from some storeroom in the basement. She sizes up the splints with the patient and chooses one. Then she makes a sling to support the leg with pieces of flannel and safety pins.
‘Start lubricating the pad will you Nurse Ross, and then I will explain exactly what I want you both to do.’
Collins has to maintain traction on the tapes while I have to stand ready to take the old splint and hand her the new one.
‘Right, pull,’ she orders Collins as she lifts the leg and extracts the splint. She puts on the new one. The ring now fits snugly in the groin instead of on the thigh as the previous one had been. She adr
oitly manoevres the cords through the pulleys and finally hangs a weight on the end. All this time the young man has hardly said a word as the morphia has quelled the pain, but after the splint is fitted, he sighs and goes to sleep.
The houseman comes on the next night to find out what had happened to his splint. I thought he would be angry but instead he says, ‘I got full marks for that splint on rounds this morning and I knew it wasn’t the one I put on. Mr Wetherby showed the students how well it fitted and how the traction worked. He praised me to the hilt. Who did put it on?’
‘Sister Busby.’
‘I thought so. I must thank her. She saved my bacon.’
This incident is my first hint of the relationship between the night sisters and the housemen. They work as a team supporting each other through thick and thin. Housemen are recent graduates from the medical school who live in the hospital and who are on call 24 hours a day. A decent night’s sleep depends on the ability of the night sisters to handle medical matters and make decisions. Dressers, who are final-year medical students, assist housemen. They work a few hours a week performing such tasks as withdrawing blood for analysis by the lab, shaving and catheterising male patients and assisting in theatre during the night.
I return from dinner one night as the phone in the foyer is ringing. We are getting an emergency. Before I have time to even enter the ward to let Collins know, the trolley arrives accompanied by a dresser, Busby and a porter. They wheel the trolley beside an empty bed but we do not put the young man into it. Huge eyes stare from an ashen face, his breath comes in short pants. His skin is icy cold.
Air hunger, I think, he must be in shock.
‘He’s been run over by a train,’ the porter tells me, ‘he works on the railways.’
‘Cut off his trousers, Nurse Ross,’ Busby orders as she administers oxygen.
I hold the cuff of one leg of his thick, navy, wool trousers and set to work with my nurses’ regulation scissors. I need shears for this job, not inadequate scissors. As I work, I notice that the hollow of the trolley made by his body is slopping with blood, which seems to increase by the minute. I decide to start at the calf by making a cut across the leg so I hold his foot to gain purchase. The foot seems to move very easily from side to side. Suddenly I realise that his whole leg is coming towards me as I pull on the foot.
‘Oh my God,’ I say, ‘his legs have been cut off!’
‘Quick, wheel him straight to theatre, I think the RSO (Resident Surgical Officer) is still there.’ Busby’s voice is calm but authoritative. ‘Nurse Collins, phone them to warn them we are coming and to have some O negative blood ready.’
They all rush out leaving me holding my little pair of scissors and trembling with shock.
Sister Busby returns later to say that we are to expect Bill Stokes back from theatre within an hour or two and to make up an amputation bed.
‘He has had a bilateral amputation and is in shock, so put the bed up on blocks. Also get an IV pole and oxygen ready.’ She turns to me and says, ‘You did very well, Nurse Ross. You kept calm – that’s important in an emergency. He was lucky – it was a crush injury. That’s why he didn’t bleed to death.’
‘Why didn’t they treat him in casualty, Sister?’ asks Collins.
‘Big flap on. Car accident. I should have examined him better and taken him straight to theatre. My fault. I didn’t know the extent of his injuries.’
Bill struggles for his life for several days. He is barely conscious. I finally get a chance to soothe a fevered brow as he runs a temperature for days and we are frequently giving him cool sponge downs. When he begins to recover a little, the agony sets in. People who have amputations still feel pain and sensation in the part that is not there and he is particularly bothered by an intense itch in one foot that he always wants us to scratch. He has only been married for a year. His pregnant wife loyally visits him every day but her visits seem to make him more, not less, depressed.
‘How can I ever be a husband again?’ he cries as tears flow down his cheeks. ‘What will my baby think of a father with no legs?’
We try to assure him that he is still a man and still loveable but he cannot be consoled.
Bill goes to a convalescent hospital in due course, to be fitted with artificial limbs and to learn to walk with them. We hear news of him from time to time but the news is not good. He suffers from severe depression until one day he has a visit from Douglas Bader, the legless airman who flew in the Battle of Britain. Doug took him in a wheelchair to the local pub where they both got thoroughly drunk. After that, Bill began to see a future for himself and his family. Two years later I heard that he visited the ward looking very chipper in a smart suit, showing off how well he could walk on his artificial legs, and proud that he had a promising office job with the railways.
Chapter 10
AFTER BREAKFAST (it is still breakfast even though we have done a night’s work), we drag ourselves to the Nurses’ Home, have a bath, make a drink and meet in one person’s room to relate the night’s events. Usually we end up screaming with hysterical laughter. A psychologist would tell us we are releasing pent-up tension because we are unable to discuss our feelings of inadequacy or describe the impact of the continual exposure to sights, sounds and smells that are beyond our experience or imagination. We revel in humour, the cruder the better.
One morning Sandy asks, ‘Did you hear what happened to Wee Jess last night?’
We wait expectantly. Jess works on a male surgical ward. She has gone home for nights off but not before telling Sandy her story.
‘They had an acute appendix in and Mr Sedgewick was in theatre waiting to do an emergency appendicectomy. Jess sent for the dresser to come to shave the patient but he didn’t come. The phone rang and a voice said, “Where the hell is that appendix patient? I can’t wait all night.”
‘Jess told him that she had sent for the dresser to shave the patient and that the patient would be there as soon as he was prepped. Well, a few minutes later the phone rings. Mr Sedgewick again. “What the bloody hell are you doing – get that patient here at once nurse, or I’ll tell the night sister how bloody inefficient you are.”
‘Jess didn’t know what to do. Should she just send the patient unprepped or what? The charge nurse was at dinner. Jess stood there dithering when suddenly a man in a white coat came barging in. She rushed up to him, thrust a shaving tray into his hands, told him which patient it was and to hurry up because a horrible man kept phoning to shout at her.’ Sandy starts to laugh and roll about on the bed.
‘Oh come on Sandy,’ Blinks says. ‘What happened?’
Sandy regains control and carries on with her story. ‘A few minutes later a dresser walked in and said he’d come to shave the patient for theatre. Jess told him another dresser was already there. “What other dresser? I’m the only one on.” “The one that’s shaving the patient,” Jess said. Then the charge nurse came back, goes to see what was going on and says to Jess, “What’s Mr Sedgewick doing shaving a patient?” Jess nearly died! Well, he and the dresser got the man on a trolley and as they passed Jess, Mr Sedgewick winked at her and said, “Next time a horrible man shouts at you on the phone, tell him to bugger off!”’
*
After Jean Smith left, Judith was moved to the neurosurgical ward. A few nights later she tells this story. She was alone on the ward, sitting at the desk when a bald-headed figure, vulnerable in a too-short hospital gown, loomed up out of the dark. She knew by the look in his eye and the way he walked towards her that something was wrong, so she hurried out of the ward to the phone. Before she could get to it, the man came out of the ward, grabbed her by the neck and started to bang her head against the wall.
‘I thought I was going to choke to death. I couldn’t get his hands off. I’ve never been so scared in my life. Just then Sister came in and the man let go. And do you know what she said?’ At this, Judith starts to laugh. ‘Do you know what she said? She said…’ Judith can hardly get the w
ords out. ‘She said, “Really nurse, you shouldn’t have let him get as bad as this.”’ We all collapse with mirth at the sheer inanity of the scene.
Judith does not often join us. One morning I go into her room to urge her to come and sit with us all. She is lying on her bed with her eyes closed, listening to a Mozart piano concerto being played on her portable, wind-up gramophone.
‘It was bad enough living through last night without talking about it,’ she says. ‘I am trying to remember that there is a more sane life outside LGI. Though one good thing happened.’
‘What was that?’
‘Marie got her comeuppance! Silly twit was kneeling beside the bed of a dying patient praying for her soul when Sister Busby found her. Tore a strip off her. Said she had no business imposing her religious beliefs on others and that praying beside a bed did not fall within the duties of a nurse. Besides which,’ Judith starts to laugh. ‘The patient was Jewish!’
Judith missed my telling the story of when I was sent to help on her ward. We were very quiet and I was told to go and help on Judith’s ward for an hour as they had had a death and an emergency admission. I laid out the body with Judith and then she asked me to check up on a patient in bed ten.
‘He smells and I think he’s had a BM, but watch out because he puts it in his locker,’ Judith said.
I approached the bed, shining a torch on it and the locker. There was certainly a smell but I could not see the source of it. All of a sudden I skidded in something, fell flat on my back and shot under the bed. I didn’t have to guess what I had slipped in as it was all over my shoe. Judith came to help me up.
‘Oh shit,’ I said.
‘You’re absolutely right.’
‘It’s all over my shoe,’ I said as I took it off.
Judith started to laugh. We were both doubled up when the night sister came in.
‘What are you doing with only one shoe on, nurse?’ She had the expression of a Queen Victoria who is not amused.
‘I stepped in something, Sister. I’m just going to wash my shoe.’ I told her.
Yes Sister, No Sister Page 8