Yes Sister, No Sister

by Jennifer Craig

  We pour our coffee and then sit down. We look at each other, waiting for someone to speak. I know that my two staff nurses will be wondering what I am like and will be cautious until they do. I suddenly feel nervous and don’t know what to say. I wonder what they have heard about me. The previous sister had a reputation for being inconsistent but they could have got on well with her and may be missing her.

  ‘Look.’ I speak first. ‘I know you may not want to work with me and if you want to move, I shall understand and speak to the office for you.’

  ‘What do you think of that, Brenda?’ Joan says. ‘She’s only been here an hour and she’s telling us we can leave.’

  ‘Maybe it’s the way we said prayers.’

  ‘Or it’s the way you wear your cap.’

  ‘Or it’s the way you made out the work list.’

  ‘Or it’s…’

  ‘Alright you two,’ I say, laughing. ‘I was only giving you a chance because I know you got landed with me.’

  ‘Oh I think we can put up with you. We’ll let you know if you become impossible,’ Joan says. ‘Anyway, Eva seems to like you. We’ve never had such good coffee.’

  ‘I took the advice of Sister Busby and introduced myself to them as soon as possible.’ I say. ‘I asked if there’s anything they need. They said they wanted help on cleaning day. Haven’t they been getting it?’

  ‘No. Sister was one of those who didn’t think nurses should help with cleaning. So it took all afternoon.’ Joan’s expression is blank.

  ‘Well I would like everyone to pitch in but I have to warn you – I intend to have a two-five.’

  ‘You rotter,’ Brenda says and then adds, ‘But I don’t blame you; I would be off if I could.’

  ‘When do you go into purple?’ I ask her.

  ‘December the first. In two months.’

  ‘Where do you want to perm?’

  Brenda grins at me and says, ‘If I can put up with you, here.’

  ‘What makes you think I’ll have you?’

  The atmosphere has become light-hearted and I know we are all going to get along. It is so important that the trained staff works well together. Friction affects the performance of the students and thus, the care of the patients. Besides the work is hard enough without sideward fights.

  The door opens and Dr Hartman’s registrar, Stewart Walker, and his houseman, Dave Ullman, walk in. I know Dave from nights but have had no dealings with Stewart.

  ‘Hello, Jen.’ Dave says. ‘Nice to see you on days. Stewart, this is Jenny Ross. She’s just come off nights.’

  A voice with a Scottish accent greets me and then says, ‘Can we do a round after coffee?’

  ‘I’d be grateful,’ I say. ‘It will help me get to know your patients.’

  Stewart trained in Edinburgh and I have not yet met an Edinburgh-trained physician who is anything but excellent. Our round reinforces my view. Stewart is thorough but gentle and the patients clearly worship him. He answers their questions with an air that he has as much time to spend with them as they need.

  Back in the sideward we discuss his patients further, saying things we would not want them to hear, such as pros and cons of treatments or their prognosis. Most of the ward business is conducted in the sideward and we frequently sit over a cup of tea or coffee exchanging information, asking advice or just chatting.

  Stewart talks about a study he wants to undertake. ‘Jenny, we give our rheumatology patients so much aspirin that I’m concerned about the state of their stomach walls. I would like to pass Ryle’s tubes into them and take specimens every morning. Is that possible?’

  ‘You mean you would like us to pass the Ryle’s tubes, not come here yourself?’

  ‘Aye. That’s what I was thinking.’

  ‘Will we get credit in the research write-up?’

  ‘Of course, of course,’ he says, but I know that nurses rarely receive acknowledgement for their part in medical studies.

  I manage to finish going round all the patients just as the dinner trolley is pushed into the centre of the ward and plugged into the floor. I roll down my sleeves, put on my hard cuffs and prepare to serve 34 meals. Joan helps me. She knows how much each patient can eat better than I do. Those on special diets are served first, then we dole out lamb stew, mashed potatoes and brussel sprouts. There is mince and mashed carrots for those who need a light diet.

  Joan is looking round the ward saying, ‘Mrs Deakin. Not much of an appetite, so give her a small helping. Mrs Jones. Her teeth don’t fit so give her mince. Miss Twaites, huge appetite. Mrs Tetley needs feeding, Nurse Harrop. And Mrs Black, Nurse Yardley.’

  We serve the pudding from a regular trolley that we push round the ward, closely followed by Eva with a trolley of tea. A third trolley holds the dirty plates. Then it is time for a bedpan round and my dinner.

  After nights it is strange to see so many in the sister’s dining room even though it is the weekend and half of them are off including Sandy. When I have settled down I will make my off duty the same as hers.

  I spend the afternoon exploring the cupboards under the stairs that hold clean linen and equipment such as lumbar puncture sets. I am responsible for the ward inventory that includes sheets, towels, equipment, plates, cutlery, curtains, beds – everything in fact. Each ward closes for one week a year to allow the inventory to be checked and missing items replaced. It is also a time for repairs and painting and I have to see that these are ordered ahead of time or they won’t get done.

  Because it is easy to lose equipment if another ward borrows it, some sisters lock their cupboards at night. This practice infuriated me when I was a night sister and needed a lumbar puncture set for example, as I had to run round the hospital to find one. I left rude messages for the offending sisters but they did not alter their ways. I intend to leave my cupboards open. After all, I don’t own the equipment even though I am responsible for it. Obtaining new supplies is a simple matter of filling out a requisition.

  I go home tired but happy. I think my first day went well. I really like Joan and Brenda and I feel fortunate to have inherited such good staff nurses. Perhaps I won’t have to wait long to make changes after all.

  Chapter 27

  Rules for the Administration of Medicines:

  1. Never give a medicine from an unmarked bottle or from one on which the label is illegible.

  2. Read the label before and after pouring a dose.

  3. Check up with the patient’s Front Sheet.

  4. Shake the bottle by turning it upside down with the finger on the cork.

  5. Hold the cork in the bent little finger while pouring the dose.

  6. Hold the glass with the mark denoting the quantity to be given on eye level and marked by the thumb.

  7. Pour out the dose with the label uppermost.

  8. Never speak, or allow anyone to speak to you, while measuring the dose.

  9. See that the patient drinks the medicine at once, never leaving it at the bedside for him to take later.

  10. Give iron mixtures with a straw, or allow the patient to brush the teeth immediately afterwards, as they blacken the teeth.

  11. Never give two medicines at the same time without definite orders, as they may react with one another.

  12. When the drug given is included in the schedule of ‘Dangerous Drugs’ it must be checked by a State Registered Nurse and entered in the poisons register.

  13. After a drug has been given, watch carefully its effect on the patient.

  ALTHOUGH CONSULTANTS ARE informed of the appointment of a new ward sister on their wards, they have no say in the selection. Theoretically they could object to the choice but I have never heard of this happening. I am greeted politely by each of my five consultants, who then carry on as usual. I spend most of every morning accompanying one or other of them on their rounds and must be prepared for these by acquiring outstanding lab reports or X-rays, and by thoroughly knowing the patients.

  Each consultant has an entoura
ge comprising a registrar, a houseman and medical students. Collectively they are known as a ‘firm’. Early on Monday morning, Jack Hartman, the rheumatologist, and his firm arrive. He introduces himself and welcomes me before we move to his first bed. He is a courteous man and seems bent on having the medical students learn to respect nurses.

  ‘What is the normal ESR?’ he asks them. They look blank and shake their heads. ‘In fact, what does ESR mean?’ Still no response.

  ‘Sister?’

  ‘It’s the Erythrocyte Sedimentation Rate,’ I say. ‘Normal values vary with age and sex but the upper limit of normal is 15mm for a man and 20mm for a woman. It rises in the acute stage of rheumatoid arthritis, which is why it is being checked on this patient.’

  He turns to the students. ‘Never forget how much you can learn from nurses. When in doubt, ask them.’

  I feel like hugging him and bless his wife who used to be a nurse here.

  Because Stewart Walker is so competent, there is little Jack adds to the treatment plans so he spends most of his round teaching the students and supervising their examination techniques.

  The first time I see Hugh Dingwall, the neurologist, I want to laugh. I know he is nicknamed Pansy Dingwall and when he appears, I can see why. He wears a morning suit of pinstriped trousers, a grey waistcoat and a black jacket sporting a carnation. His appearance defies his reputation of being a brilliant diagnostician and I have to resist the urge to sing ‘Burlington Bertie from Bow’.

  I had also heard that he has an eye for the girls. As we stand at the foot of a bed listening to the houseman report on the patient, his eyes are focused on the legs of every nurse who walks by. He looks as though he isn’t listening but I soon find out that he doesn’t miss a trick. Many of his patients are suffering from the neurological aftermath of syphilis that they usually acquired in their youth and which has lain dormant all their lives. It is tragic to see these women with paralysis of their limbs or with locomotor ataxia in which there is pain and loss of position sense. Once the diagnosis has been made from a positive Wasserman test, there is little treatment to offer except penicillin, which has a minimal effect at this stage.

  Sideward life becomes more and more lively as Joan, Brenda and I get to know each other better and to appreciate each other’s humour. Joan is very Yorkshire with her direct, down-to-earth approach. ‘Bluddy ’ell,’ she’ll say, ‘that Potts woman is chuntering on about her bowels again. It’s driving me spare.’

  Brenda is energetic and enthusiastic. It is to her that I first mention that I want to initiate daily teaching sessions, and instead of ‘We don’t have enough time,’ or ‘Do you really think you’ll get the housemen to teach?’ she says, ‘Wonderful. When do we start?’

  ‘Let’s talk it over with Joan,’ I say.

  The three of us discuss how the morning routine can be changed so that the nurses finish at 11.30 instead of 12 noon, leaving half an hour to sit down for a talk.

  ‘I’ll teach them about some of the medicines that patients are on,’ Brenda says. ‘In fact, I’ll start a Materia Medica.’

  ‘I can yak about neurological stuff,’ Joan says.

  ‘I know more about medical conditions so I’ll prepare a session on chronic bronchitis,’ I say. ‘And we’ll rope in the housemen,’ Brenda says. ‘When shall we start? Tomorrow?’

  ‘Why not?’ I am so pleased at their response and I can feel my own enthusiasm rise with theirs.

  The next day I explain to the nurses what we are going to do. Despite cutting out the round of lockers it is difficult for them to finish earlier than usual but we do manage to gather round the table at 11.40 and I give a talk on chronic bronchitis, a condition that brings in perennial patients at the first November fog.

  Even though the session may be for only ten minutes, we manage to hold one every day. The housemen are keen to join in and I am delighted with the eagerness shown by everyone. The student nurses seem more energetic and I remember how I felt after a teaching session with Busby.

  I order a supply of folders and paper. When they arrive, I make up a folder for each student nurse and assign each a patient. I explain that they are to write up the condition, medical treatment and nursing care of the patient and to make daily progress notes. They are to go to the library to read about the disease and they are to find out about the action and toxic symptoms of each medicine their patient is on. Their notes will be kept in the box that hangs from the end of the bed to hold Front Sheets for doctor’s prescriptions, intake and output records and other notes.

  Once the nurses have become accustomed to the task, I make a point of reading the notes when I do a round and I try to remember to comment on them. We have the nurses present their cases at some of the teaching sessions. Although they are nervous at first, they are stimulated by the experience.

  One afternoon when the ward is quiet and there is an extra nurse on duty, I assign a first-year student to give out medicines under my supervision. A metal cupboard on legs tall enough to bring the cupboard to eye level is wheeled to the foot of the bed and the medicine is dispensed there. The prescription is checked against the Front Sheet, the medicine is poured and a record is made on the chart. Nurse Carter is clearly anxious.

  ‘You have plenty of time,’ I say. ‘Don’t worry if you’re slow. There’s such an array of bottles it is difficult to find the right one at first.’

  She settles down and begins to enjoy herself as she shakes out pills on to a teaspoon and measures liquid medicines into small, glass measuring cups. I explain the action of the medicines and have her refer to the Materia Medica that Brenda started in a hard-covered notebook with an alphabet index.

  I read out, ‘Sulphonamides. Salts of sulphonic acid. Action is to inhibit the growth of certain bacteria but does not kill them. Bacteria sensitive to sulphonamides are streptococci, staphylococci, pneumococci and meningococci. The sulphonamides are excreted rapidly so they should be given at frequent intervals. Their action is assisted by alkalis. They should be given with plenty of fluids (4–6 pints) to prevent crystallisation in the kidneys.’

  I stop reading to say, ‘That’s why Mrs Hall is on I & O.’ I pick up the book again. ‘A course of treatment should not exceed six days. Administration is usually by mouth in the form of half-gram tablets. Toxic effects can be nausea, vomiting, cyanosis, skin rashes (like measles), suppression of urine, fever, agranulocytosis and haemolytic anaemia.’

  Although it has taken three times as long as usual to give out the medicines and I am behind in my work, I am pleased with my effort. I realise how much I like teaching. It thrills me to see how earnest these young women are when they are learning something new and how they carry on with their work with renewed vigour.

  ‘There’s something else I want to try,’ I say to Joan and Brenda one day.

  ‘Oh cor strewth, what now?’ Joan asks. ‘Well you don’t have to do it but when I’m on tonight I’m going to reverse the work list and do kitchen and bedpans.’

  ‘I thought she was barmy when she first showed up and now I know she is.’ Joan says. At five o’clock, when I come on duty, I write the work list:

  As the nurses come on and read the work list, I watch their reactions. Nurse Tindale says, ‘I think there must be some mistake, Sister. You’re down to do kitchen and I’m down to be in charge.’

  ‘There’s no mistake Nurse Tindale. You take finals soon and I want you to know what it’s like being in charge before you are suddenly a staff nurse.’

  ‘But Sister, I don’t know what to do!’

  ‘Of course you do. You’ve been in charge on nights and it’s much the same. Anyway, I’m here if you need me. When the Ass. Mat. comes I will tell her you are in charge and ask her to take the report from you. You just take her to the sickest patients who are on this list. I’ll give you the report now.’

  I give the report and then I go out into the foyer, plug in the food trolley and stack it with plates. I set a trolley with cutlery and water jugs and
I am just about to wheel it into the ward when an Assistant Matron comes in. She is here to collect the report of the sickest patients. I tell her that Nurse Tindale is in charge this evening and would she receive the report from her. She seems surprised but nods in agreement.

  I start to set bed trays with knives and forks, fill water glasses and retrieve napkins from lockers. It is surprisingly relaxing to do these chores that I once hated. I check a couple of Dangerous Drugs and some insulin with Tindale but otherwise she is managing splendidly.

  At suppertime, Tindale serves and I feed patients. Then I put on a pink gown and do a bedpan round.

  I am thoroughly enjoying myself. When that is finished, I go into the bathroom to wash rubber draw sheets with carbolic. While I am there, Nurse Yardley comes to tell me that we are getting an acute, a patient in status epilepticus, which means that the patient is having a continuous epileptic fit. It is a medical emergency and requires immediate attention or the patient will collapse.

  I watch through the bathroom door window to make sure that Tindale knows what to do. She is pushing over an oxygen cylinder to the bed and Nurse Yardley is setting up a tray with a wooden wedge to hold the mouth open. The houseman is there. Tindale gets an injection tray and prepares a syringe, of paraldehyde I expect.

  I wander into the ward and can smell the sickly, sweet aroma of paraldehyde before I reach the bed. ‘You seem to be coping beautifully,’ I say to Tindale. If she was on nights, she’d be doing just what she is doing with only a visiting night sister.

  ‘I saw you hovering behind the door,’ she says accusingly.

  ‘I would have come out if I thought you needed help or weren’t managing but you were. I’ll wait until this patient stops fitting and then I’m going for supper,’ I say.

  Tindale gives the report to the night staff while I listen and interject only when it’s information she couldn’t know. As we both go off duty, she turns to me. ‘That was a really good experience. Thank you so much for your trust.’

  On 1 December Brenda comes on duty at 8am in her new purple uniform. I now have two perms. I wonder how long I will be allowed to keep them before the office intervenes. Normally, a ward has one perm and one or two staff nurses. We have a little party for her in the sideward. I brought in some cakes and the men, who have been forewarned, show up all at once, Stewart with a bunch of flowers for Brenda.