by Kate Eastham
Maud did her absolute best to both supervise and encourage Nurse Latimer. But when an admission came through the door later that morning, she was straight there with Sister Pritchard. And she couldn’t help but feel relieved when she realized that she might be able to escape into theatre.
‘This is Mrs Freda Martin, fifty years old, reporting nausea and sudden pain in the lower abdomen. She doesn’t have any family but her neighbour, a Mrs McCluskey, was very concerned about her and will be along at visiting,’ called Michael Delaney, leading the way on to the ward at the head of the stretcher, with Stephen Walker almost running at the rear.
Maud smiled to herself. It seemed that the orderlies were now gaining so much knowledge and experience that they might well be ready to help out in theatre themselves soon.
‘Bed six, please, Michael,’ ordered Sister Pritchard, as Maud took the patient’s hand.
‘You’re safe now, Mrs Martin,’ she soothed, noting her patient’s pallid face and grey hair, plastered down with sweat. ‘We’re just going to get you into bed so that we can have a proper look at you.’
Mrs Martin tried to speak but then she scrunched up her face and groaned in pain.
‘Let’s try to make you more comfortable,’ urged Maud, suspecting that this was indeed a genuine surgical case – possible appendix, or maybe a ruptured ovarian cyst.
‘Bring the screens, please, Nurse Latimer, and then could you get the ward thermometer and make a recording of her temperature,’ she called, as she assisted Sister Pritchard with settling their patient in bed. The poor woman was still scrunching her face up, and gripping Maud’s hand so tight it hurt.
‘I’ll just get you something for the pain,’ Sister said, turning to speak quietly to Maud. ‘I don’t want to mask her symptoms before Mr Jones is able to examine her, but let’s try some laudanum to take the edge off.’
Maud nodded, speaking softly to the patient, telling her what they were going to do.
Whilst Sister was away, she checked the radial pulse – it was rapid – and then she assisted Nurse Latimer with the use of the thermometer, making sure their patient remained still for the required time. She left Nurse Latimer sitting with the patient whilst she attended to other duties. But as soon as Mr Jones was ready to examine, Maud was there by the bed.
‘If you could move over on to your back, please, Mrs Martin,’ she said gently. ‘That’s it, now if I could just slip up your nightdress.’
Mrs Martin groaned sleepily and nodded.
Even before the nightdress was lifted, Maud could see that the woman’s abdomen was very distended, almost like a pregnancy. She suspected that her potential diagnosis of a ruptured ovarian cyst might well be correct.
‘Ah,’ said Mr Jones, glancing across to Maud, as he pressed Mrs Martin’s abdomen, ‘you seem to have quite a collection of fluid in your belly.’
‘What?’ groaned Mrs Martin. ‘That can’t be good, can it?’
‘You’re right, my dear,’ confirmed Mr Jones, ‘but it might not necessarily be very bad. We will, however, have to take you into theatre and make an incision in your abdomen to find out exactly what the problem is.’
The woman started to cry.
‘Try not to upset yourself,’ murmured Mr Jones, pulling down the nightdress to cover the bump of her belly. ‘Surgery such as this is starting to become almost routine, these days.’
The woman was still crying, and Maud took her hand.
‘Will you stay with me, Nurse?’ she pleaded. ‘I want you to stay with me.’
‘Yes,’ Maud reassured her. ‘But they will give you some chloroform to put you to sleep before the operation, so you won’t know anything about it.’
‘Will they?’ said the woman, her eyes wide. ‘Are you sure?’
‘Yes, I’m sure,’ smiled Maud, patting her hand.
‘Thank the Lord for that,’ murmured the woman. ‘I lost me mother and me father on the operating table. They died screaming.’
‘Well, we don’t have anything like that, these days,’ soothed Maud. ‘We have very modern techniques now.’
‘You’re an angel,’ smiled Mrs Martin, and then her face convulsed as the pain struck her once more.
‘I’m going to leave you now with Nurse Latimer whilst I go and get things ready for the operation, but I’ll see you in theatre. I promise.’
The woman was writhing on the bed now. Maud gestured for Nurse Latimer to take her hand and was relieved to see the probationer do so with a flash of genuine concern for her patient. Maud walked briskly up the ward, speaking first to Sister Pritchard about the suspected diagnosis and then confirming that she could take charge of theatre.
Maud took a deep breath as she entered the hallowed space. In less than ten minutes, she had her hands scrubbed and the shiny instruments, enamel bowls and the wooden theatre table ready and waiting and sprayed with carbolic acid. As soon as Michael Delaney appeared through the door, leading the way with the stretcher, Maud was there by her patient’s side, giving reassurance.
Mrs Martin was starting to groan again with pain as Mr Jones came through the door. He nodded to Maud and went straight to the sink to scrub his hands. Maud could feel her patient clinging tightly to her hand now. She spoke soothingly, telling her to take some deep breaths, in and out, telling her that the doctor with the chloroform would be there soon.
Mr Jones was finishing his customary smoke in the corner of the room before Dr McKendrick slipped in through the door. Maud smiled with relief.
‘So sorry,’ he murmured, ‘I was called to Male Medical to give a morphia injection to a heart failure patient. It took him a while to settle.’
Mrs Martin was starting to draw up her knees and cry out with pain now.
‘One more minute,’ soothed Maud. ‘Now let’s put this piece of lint over your nose and mouth. No need to worry. Now we’re just going to put the drops on to the lint, and I want you to take some deep breaths. It will smell strong, but don’t worry, it will put you to sleep. And when you wake up, the operation will be over.’
Maud could see the terrified look in the woman’s eyes above the mask formed by the lint. ‘It’s all right, Mrs Martin,’ she soothed, ‘I’m going to stay with you, and I’ll be here when you wake up. Now, the drops are going on, breathe deeply. Just breathe.’
Mrs Martin hung for a moment in a place of pain, her eyes wide.
‘Try to let go,’ Maud murmured, breathing with her. ‘That’s it,’ she said as, finally, the woman closed her eyes.
‘You nearly put me to sleep there as well, Nurse Linklater,’ smiled Dr McKendrick. ‘You have a very soothing voice.’
Maud pursed her lips. Harry had always liked her voice … ‘Right, Mr Jones,’ she said, energetically, ‘do you have all the instruments that you need?’
‘Yes,’ said the surgeon, casting a careful eye over the side table. ‘And do we have a bucket and plenty of towels? If this is an ovarian cyst, given the size of her abdomen, I think there will be a great deal of fluid in there.’
Maud indicated the bucket placed ready on the floor and the towels waiting on the shelf. And then she pulled up the patient’s nightdress to reveal the distended abdomen. Once she’d sprayed the skin with carbolic acid, she indicated that they were ready.
‘Let us begin,’ said Mr Jones, brandishing his surgical knife.
He made an expert incision, about seven inches long, from the patient’s umbilicus to the top of the symphysis pubis. Maud saw the first dots of red springing from the cut and readily applied lint swabs.
‘Now, Nurse Linklater, I’ll cut down through the muscle to the peritoneum. What is the peritoneum?’
‘The membrane that lines the abdominal cavity and covers the internal organs,’ replied Maud.
‘It is indeed,’ murmured Mr Jones, applying the knife carefully to complete the next stage of the incision. ‘And there it is.’
Maud peered into the wound, nodded her head and then started dabbing with swabs again.
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br /> ‘Now, I’m going to puncture the peritoneum,’ he said, picking up another knife. ‘Do we have the bucket ready to collect the fluid? I think it will burst out very quickly once it’s released.’
‘Ready,’ said Maud, reaching down to pull up the bucket. ‘Could you take some towels as well to the other side?’ she asked Dr McKendrick.
With one stroke Mr Jones punctured the peritoneum, and a spurt of pale yellow fluid gushed from the abdomen. Maud was able to catch some in her bucket but most of it needed to be hastily mopped up with towels. The fluid flowed and flowed as Mr Jones pressed on the woman’s abdomen.
‘There must be pints of serum there,’ he murmured, still watching as more and more poured out. ‘That was a hell of a cyst.’
Unable to capture a clearly defined leakage of fluid now, Maud had abandoned her bucket and was using towels to mop up alongside Dr McKendrick. She could see that his neatly rolled shirt sleeves were already saturated, as were the sleeves of her uniform and her apron.
When at last the flow of fluid subsided, Mr Jones pulled apart the wound with his hands and peered inside. ‘There’s our cyst,’ he remarked, triumphantly.
‘How is she doing, McKendrick? Sometimes a sudden release of pressure like that can significantly weaken the patient.’
Dr McKendrick was already checking Mrs Martin’s pulse and observing the rise and fall of her chest wall. ‘Her pulse is still rapid and a little weaker but her breathing is strong. We’re not going to lose her just yet, but we do need to proceed quickly, if at all possible, so that I don’t need to administer any more chloroform. I don’t want to suppress her vital functions any more than necessary.’
‘Righto,’ said Mr Jones. ‘Stand ready, Nurse Linklater, I’m just going to puncture the cyst and release the remains of the fluid.’
Maud had a towel there at the ready as more fluid gushed from the wound.
‘Now, let’s cut the blighter out, and the ovary as well,’ said Mr Jones, both hands now deep inside the patient’s abdomen.
Maud passed a knife and, minutes later, Mr Jones pulled out the mass of the cyst. The way he delivered it through the longitudinal incision in the woman’s abdomen reminded Maud of a Caesarean section that she’d seen at the Women’s Infirmary in New York. It made her feel sad and even more determined not to lose this patient, remembering that both the mother and the baby had died that day.
Maud had a bowl waiting – she was surprised by the weight of the cyst. No wonder the woman had been in so much discomfort.
‘Clamp,’ wheezed Mr Jones. ‘I need to secure the pedicle and apply ligatures.’
Finally, Maud passed swab after swab so that Mr Jones could mop up the residual fluid in the abdominal cavity. Deftly taking the used swabs with one hand and giving him clean ones with the other, she soon had a mound of sodden swabs in the bowl on the floor.
‘Righto,’ he said, straightening up. ‘We can close now.’
Maud passed needle, forceps and suture thread as Mr Jones prepared to secure the peritoneum, muscle and then the skin. By the time he had tied off the final suture, Maud could see beads of sweat standing out on his forehead. She used a lint swab to mop his brow.
‘Thank you, Nurse Linklater. These are always a messy business,’ he murmured, looking down to his stained trousers and the sleeves of his shirt, saturated to the elbow. ‘I’ll scrub my hands and then go to my rooms for a complete change of clothing. Will you two be able to manage the rest?’
‘Yes,’ replied Maud and Dr McKendrick, together.
Maud wiped the whole area surrounding the wound with swabs soaked in carbolic acid, before applying a square of lint. Then Dr McKendrick helped her roll the patient so that she could apply a flannel bandage around the woman’s torso to secure the dressing.
‘What do you think, Nurse Linklater?’ he mused. ‘Will she be at least a stone lighter without that huge cyst in her belly?’
‘Probably, yes,’ agreed Maud, just as Mrs Martin let out a groan.
‘Sounds like she’s waking up,’ said Dr McKendrick. ‘And with all that she’s been through, she’ll have a great deal of pain, so I’ve already prepared a fifth of a grain of morphia that I’ll administer as a subcutaneous injection.’
‘Yes, good idea,’ said Maud, taking hold of Mrs Martin’s hand.
‘Hello. You’ve done very well,’ she said gently, as the woman blinked open her eyes. ‘We’ve removed a very big cyst from your belly and all of the fluid has gone.’
Mrs Martin managed a weak smile. ‘Bless you, Nurse,’ she said, squeezing Maud’s hand.
‘Now we’re just going to give you an injection. You’ll feel it sting, but that’s to help with the pain that always comes after an operation.’
‘That’s fine …’ murmured Mrs Martin, still smiling.
Once her patient had been removed from theatre, Maud surveyed the scene – bowls of sodden swabs, a bucket full of serous fluid, a mound of wet towels. The floor and the table were awash with fluid and blood and a pile of used instruments. She looked at her hands, stained with blood, and then at her sodden apron.
‘Phew,’ she breathed, wondering for a moment where to make a start with the cleaning up.
The door opened and Alice came through. ‘I’ve come to help you clean up,’ she said, starting to roll up her sleeves.
Maud bowed her head. She felt too exhausted to still feel irritated at not being told about Nancy turning up at her wedding. And yet, she couldn’t help but feel let down, once again, by Alice and Eddy.
‘I’m sorry, Maud,’ said Alice, quietly, from the other side of the theatre table. ‘It’s just that we would have had to tell you at your wedding, and it didn’t feel right to do that. And for all we knew, you were going away to America for a very long time and you’d be well out of the way of Nancy. We had no idea that she might be—’
‘It’s all right,’ said Maud, lifting her head, ‘I understand. And I probably would have done the same. You weren’t to know … about the baby.’
Just in that moment, standing amidst the mess and disorder of the used theatre, Maud could have wept. She took a deep breath and looked Alice in the eye. ‘None of this is your fault, Alice,’ she said. ‘It’s Harry and Nancy’s doing. But please tell me now if there are any more secrets that you’ve been keeping.’
‘That’s it, I reckon,’ murmured Alice. ‘I’m sorry, Maud.’
‘Oh no, please don’t worry, Alice,’ soothed Maud, making a move to hug her.
But her friend drew back. ‘Ugh, you’re all full of stuff.’
‘I am, aren’t I?’ said Maud, looking down at her apron and starting to giggle, and then she was laughing out loud and not wanting to put her soiled hand over her own mouth.
Alice placed her own clean hand over Maud’s mouth as she stood there, desperately trying to hold back her laughter, and then she led her to the sink so that she could start to wash her hands.
‘I love you, Maud, and Eddy does, too. You know that, don’t you?’ said Alice, her voice husky with emotion.
‘Yes,’ said Maud, ‘of course I do.’
16
‘Remember, every nurse should be one who is to be depended upon … she must be no gossip, no vain talker … she must be strictly sober and honest.’
Florence Nightingale
Maud and Alice scrubbed and cleaned the theatre until it was shiny and new and not a single instrument was out of place. When they finally emerged back on to the ward, Sister Pritchard took one look at their bedraggled state and sent them straight to the laundry for clean uniforms.
‘Have you met the new laundress?’ said Alice as they walked along the corridor and then out through a side door.
‘No, I haven’t,’ replied Maud, looking down at her ruined uniform. ‘But now that I see all this in broad daylight, I know that I’m desperately in need of her services.’
‘Me, too,’ laughed Alice, linking Maud’s arm. ‘And I only helped with the cleaning. Well, the laundress is cal
led Dolly, and she was with Miss Houston, Ada, out in the Crimea.’
‘Really?’ said Maud. She was intrigued, as always, by any mention of the Crimean War or her personal heroine, Florence Nightingale.
‘Was Dolly a nurse?’
‘No, she was a laundress out there, too. I think, before that, she’d been an army wife who’d disguised herself as a rank-and-file soldier so that she could go to war with her husband. Or so the story goes.’
‘No, that can’t be true, surely?’
Alice was nodding. ‘That’s what Ada told me. And apparently, there were other women who did that as well. One of them even gave birth when she was serving alongside her husband.’
‘Really?’
‘Yes, really.’
‘Well, it must be true if Miss Houston told you. She would know.’
‘She told me other things about her time in the Crimea as well, about that doctor she worked with out there. And I know you said that I wasn’t to tell you—’
‘No, Alice. You must not tell me. That’s one secret you have to keep. You promised Miss Houston.’
Alice sighed with exasperation. ‘Well, I’m not really sure about part of it, but there is one thing that is obvious … and I can only hope that Miss Houston tells you about it herself, one day. Because it’s burning a hole in me, having to keep it all to myself.’
‘Oh, Alice, you are so dramatic sometimes,’ smiled Maud, pulling her close. ‘Come on, let’s get our clean uniforms and get back to the ward.’
As soon as Maud returned to the ward, she went straight to Mrs Martin and was relieved to find her still sleeping peacefully from the injection of morphia. Discreetly lifting the corner of the bed sheet, she checked the dressing for any seepage of blood and was pleased to find it clean and dry. Then she placed two fingers on her patient’s wrist to check the radial pulse and glanced at the temperature chart. She could tell by the careful hand that the most recent reading had been made by Nurse Latimer and was pleased to find that there was only a slight elevation of degrees Fahrenheit.