Part 6

Then the question arose what to do with the cat, as it appeared to be hungry, and not inclined to be quiet; so eventually the most innocent-looking lady pupil was deputed to go to the home sister, and tell her she had caught this strange cat in the bathroom, and, as it seemed starving, might she go down and feed it, and then turn it out? The home sister was fond of cats, and her sympathies were aroused; so she assisted in providing it with supper and seeing it off the premises.

In November I was sent on night duty. The lady pupils are not obliged to do night duty, as they are only here for one year; but Matron was short of senior probationers, and asked me if I would like it, and I thought I would. Part of the time I have been an "extra," just helping wherever they were busy, and helping in the theatre for any night operations. Then I was put on as "special" with a tracheotomy (diphtheria) in a men's medical ward--such a nice boy, called Albert, aged eight. And, when he was getting better, another little chap of three came in, so desperately bad that they had to do tracheotomy in the receiving room; and then he was brought over and put in a cot by my boy's bed, and I looked after them both. Poor Albert was rather jealous at first, and whenever I was attending to the small boy he began to "wheeze" too, thinking I should rush to his rescue; but he soon found that that did not pay.

After these boys had both recovered, I disinfected, and had a night off to air myself; and then Matron let me do the staff nurse's nights off--very interesting, but rather anxious, work.

You go to a ward which perhaps you have never been inside before, and you don't know where anything is kept. There are from twenty to forty patients; if the latter, there is a probationer to help you. Most of them are sleeping quietly; the few who are awake are probably wondering what sort of a rise they can take out of the strange nurse.

Some of the sisters are very good about giving one a full written report; but other sisters are rather casual, telling you much of what you may or may not do for number eight or number eleven, but seeming impatient if you try to jot down notes.

The first night off I took was in a men's surgical ward, where there was a nice lad of eighteen who had had his leg amputated that day (for a tubercular knee). He was so good and patient, but of course he needed a good deal of attention, and I wished I could stay with him all the time; but there was an old man at the other end of the ward rather delirious, and he would insist upon saying his prayers with a loud voice, and confessing his sins to me, calling me "Maria, dear." I was thankful when the house surgeon came round and ordered him a sleeping-draught; but it took me quite half an hour to persuade him to drink it, and then it was a long time before it had any effect.

In another ward the sister told me that the patients needed nothing to be done for them until I gave them their breakfast in the morning, but "_would_ I take great care of her Persian and Manx cats, and not let them escape from the ward?"

It was also airing night, so I had plenty to do airing sheets, &c., and putting on clean sheets in the morning; but it was not exciting.

To-night I am staff nurse in the men's accident ward; but there is a bright little pro. on as well, and she seems to be accustomed to do most of the work. We have had one case in--a van-boy with slight concussion of the brain; but I have got him washed, and he is now asleep with an ice-bag on his head. There are several bad cases in the ward, but they all seem inclined to sleep; so I am actually sitting down to finish up this scribble to you.

I like night duty; you seem to have more time to fad over the patients who are really bad, and to do little things for their comfort; and the convalescent ones generally sleep and don't worry you; but it is hard work sometimes, especially between 5 and 8 A.M., when every one wakes up, and every one wants something, and there are all the breakfasts to give round, and all the beds to make, and the temperatures to take, and the fomentations to change, and a hundred different things all needing to be done at once; and you rush around and expect every minute the day nurses will come in and say "What a muddle the ward is in!" and sometimes, when you are beautifully forward with your work and think Sister will be pleased, a house surgeon runs up in his pyjamas and dressing-gown to say he is sending in a bad case, and then you have to give all your attention to that case, and can't do the final clearing up for which you thought there would be heaps of time!

XV

GENERAL HOSPITAL, LONDON, _June 1895_.

Many and various are the jobs I have done since my last letter, and now I must tell you that I am a full-blown Sister or, as they say here, I have got "my blue"; but I had better begin where I left off.

I was then bustling about on night duty, and I spent a very happy Christmas like that. Of course, we should all like to be at home for Christmas, but in hospital so much is done to make it bright and cheery for the patients, and so many of them have so little brightness in their lives, that it is nice to see how thoroughly they enjoy it.

They all have really nice presents; there is any amount of good food provided; plenty of entertainments (music, Christmas trees, &c.); and the men are allowed to smoke in the wards.

The doctors and students are really splendid in the way they work at decorating the wards, &c., and carrying the patients who are well enough about to other wards for entertainments.

The children of the slums around here will do anything to get into the hospital for Christmas, and the front surgery is full of little imps who have all got a "very bad pain!"

In January I had to retire to bed for a few days with a high temperature and a touch of influenza, and while I was in bed the day came for the dispensing exam., so I begged to be allowed to go, and vowed I was quite recovered, and they let me attend.

I made up my prescriptions (a bottle of medicine and some powders), and then I got under way with the paper, and thought it was rather a nice one, but before I reached the end my head began to swim, and I felt convinced I had mixed everything up and given all the wrong doses, and I thought what an ass I had been to try it, and I was certain I should come out at the bottom of the list!

One of my friends escorted me back to bed and took my temperature, and when she found it was 103 she went off and told the Matron; so next morning the doctor appeared, and I was kept in bed for a whole week, and then sent away for a few days' change, but before I went away Matron came to tell me that I was first in the dispensing exam., with 114 marks out of a possible 125. If I had any more exams. to go in for, I think I ought to arrange to have a little influenza beforehand, as it seems to stimulate my brain; but, thank goodness, that is my last.

You know I have always vowed that nothing would induce me to be a matron? Well, I have been rather near it; I have been acting as assistant matron for some time. First of all, the assistant matron was ill, and went away for a bit, and I did her work; then, when she came back, Matron went away for a fortnight, and I stayed on in the office helping the assistant.

It was rather interesting learning the ins and outs of the "Administrative Department," but I am still convinced that it is no catch to be a matron.

Sisters come to complain of a nurse, and you have to send for that nurse and scold her for her reported misdeeds, when, perhaps, all the time you have rather a feeling that Sister has been unreasonable in what she has expected of the girl.

Then nurses have a way of sometimes getting ill, and it always seems to be the nurse whose place it is most difficult to fill; then Matron goes out for the afternoon, saying to the assistant, "There are three extra nurses, and I have sent them to Wards A., B., and C., where they are busy, so no one is likely to ask you for another extra," and as soon as she has gone a house surgeon runs in to say he has sent in a very bad diphtheria case to Ward D. for immediate tracheotomy, and can I send specials over at once? I look on the list to see who the three extras are, and find not one of them is suitable to take on the case--one is going for her holiday in a few days and the other two are quite juniors--so I rack my brain to think which of the ward nurses is most suitable, and fix upon Pro. 1 in Ward A., as she has nursed one or two tracheotomies; so I have to interview Sister A., and she is most reluctant to give up her Pro. 1, and is quite certain Matron would not have taken her away, but I have to be firm and try to console her by sending her the best extra in place of Pro. 1 (thereby incurring black looks from Sister B., who is quite sure her ward is far heavier than Sister A.'s!); some one ought to be sent to bed to be ready to act as night special, but I conclude that can wait till Matron returns, as she may have some nurse she has promised to put on as special. That is the sort of work the assistant matron has to do--a good deal of fagging about and acting as a sort of buffer between the sisters and the Matron, much writing of letters and other work in the office, and a good deal of carving at meal times--one Sunday I carved roast beef for seventy nurses, some of them day nurses and some of them night.

I had just come to the end of my time in the office (I was still a lady pupil then), when an appeal came to the Matron to lend two staff nurses to one of the large London Infirmaries, where they had a great many nurses ill.

I volunteered to go (as I thought it would be a new experience), and then another lady pupil also volunteered.

It was a pouring wet evening in March when we set off in a hansom cab, the other lady pupils rather jeering at us, and saying that when _they_ went to the workhouse they should do the thing correctly in an aged four-wheeler!

We had no idea where the Infirmary was, but trusted to the cabby, and after a long drive he turned into a stone-paved yard and drew up at a heavily-barred door; it looked more like a prison than an infirmary, but I got out in the rain to explore, and after a little while I managed to explain to the old man in charge that I did not wish to apply for admission to the Casual Ward, but to find the Infirmary. He told me that was more than a mile farther on; so the weary horse plodded on once more, and eventually brought us to an imposing building, where, in three weeks of hard work, we learnt many things.

They were very busy and very short-handed. I was sent to a women's medical ward of thirty-two beds, but the place was so full that I had thirty-six patients, the extra ones sleeping on mattresses on the floor. For the first week, whenever a patient came in, I had to consider which of those in beds was the most capable of turning out and descending to the floor, to make room for the new-comer, but after that things quieted down, and before I left the patients were reduced to the correct number.

There was a sister in charge of my ward and of another one just opposite of the same size. For a few days I worked with the staff nurse, and then she had to leave, and I was left to do the work of the ward with the help of a probationer, who came in for an hour and a half every morning, and who relieved me when I went off duty every other day; and on the alternate days, when the staff nurse from the opposite ward was off duty, I had to patrol her ward at intervals, and give the probationer any help she needed.

At first I was appalled at the small number of the nursing staff for so many beds, but I soon found that everything was done in a way very different from our hospital methods, and that if we worked hard and fast it was possible to do all that was really necessary for the patients, but quite impossible to do the little faddy things that make so much difference to their comfort.

For one thing, the convalescent patients were expected to do a great deal of the routine ward work, and, as a rule, the convalescents stayed in much longer than they do in a hospital, so they were more fit to assist, but this hardly applied to my short time in the Infirmary, owing to the great pressure on the beds; also I found that there were only about six or eight out of the thirty-six patients really acutely ill, so I was able to give most of my attention to them--three of them were absolutely helpless, and needed much care and nursing.

The rest of them were chiefly old ladies who were just not strong enough for the workhouse life, and so were drafted into the Infirmary; most of them were able to get out of bed and potter about the ward. This they loved to do with very scanty clothing on--rather to my horror--and I found that when a doctor was sighted on his way to the ward it was best to clap my hands vigorously, when all the old dames scuttled into bed like so many rabbits into their holes.

Poor old things, several of them had evidently seen better days, and there were many sad stories to be listened to, and they did so much appreciate the little I could do for their comfort.

It was very hard work, as one always seemed to be working against time, but I quite enjoyed my three weeks in the Infirmary. Matron had not told us we were to be paid for this work, so when we each received £6. 6s. for the three weeks, we felt very rich!

We were quite glad to return to our good old hospital, and since then I have been doing Sister's holiday work, and now I have just been appointed Sister in the front surgery (where all the new cases and accidents come in); it is utterly different from being in the wards, but I think I shall find it interesting--at any rate for a time. I shall wait to tell you about it until I have been here a little longer, and have taken my bearings more correctly.

XVI

GENERAL HOSPITAL, LONDON, _January 1896_.

I think I shall be rather glad when I get a ward of my own and settle down; but every one seems to think I am lucky in getting such varied experience, so I suppose I ought to be grateful, and it is not yet two years since I first entered here.

I spent six months as Sister in the front surgery, and it was very interesting.

There had never been a sister in charge there before, but just one old staff nurse, who had let the dressers do just what they liked, and there was a lot of waste and much disorder.

Matron gave me a very good probationer, and she was just as keen on getting the place nice and trim as I was. It took us a week or two to get all the drawers &c., scrubbed out and tidy, and a good many more weeks before we got all the splints sorted and padded.

The Medical Superintendent was pleased, because I managed to reduce the cost of dressings every week from £10 to £7 before I had been there a month, and it was still further reduced after a few more weeks.

Of course it is difficult for young dressers (who come on for only three months at a time) to understand how much difference a little extravagance in each dressing makes in the weekly bills; and they can't be expected to know the relative value of different kinds of wool, &c., unless it is pointed out to them, but as a rule, when they do understand, they are quite willing to use the cheaper dressings (for cases where they do just as well) provided that we keep a supply ready to their hands.

I often wonder whether, when people go round a hospital and see the rows of white beds and clean patients, and everything neat and tidy, they think the patients arrive here looking like that. Very often in the wards, when the porters have carried up an accident case on the stretcher, I have hardly known how to get the man's dirty clothes off, and it takes time before you can get them reasonably clean; but in the wards you always receive a note or a message by the porter from the house surgeon, with a rough diagnosis of what the case is, so that you know which limb to be especially careful in moving. But it is different when you receive a patient in the front surgery; the policemen tramp in and deposit the stretcher on the floor, and there is much mopping of their foreheads before they tell you roughly what they know of the accident, and then you have to proceed to find out for yourself what is the extent of the injury, and often the patient is quite unconscious, so he cannot help you at all.

I think at first I had a dim notion that every case that was carried in on a stretcher was sure to be admitted to the wards, but one soon learns that a good many of these cases are more frightened than hurt, and after a little rest and a thorough overhaul by the house surgeon they are able to go home again; on the other hand, every now and then a man who has had a very serious accident will manage to walk up to the hospital, and he may even sit down amongst the other waiting patients and quietly wait his turn to be seen, unless you happen to be on the look-out, and note that he is looking ill, and get him on to a couch for immediate attention.

There is generally plenty doing in the front surgery, and whenever any of the men have nothing better to do they stroll in to see what is going on, so one hears all the gossip of the place; very quaint, too, are the tales the patients tell of their symptoms. I am not good at remembering these things, but there was one old lady who said the doctor told her that she had "the brownkitis, and that all her tubs (tubes) were full up."

Sometimes we had exciting times. I remember one morning when I came on duty the night nurse reported that a bad case of compound fracture of the jaw and other injuries had come in, and been taken straight up to the theatre, and that the house surgeon and all the available dressers were busy with it then. She had no sooner gone away than in tramped four big policemen with a stretcher, which they deposited on the floor; on uncovering the patient I found a poor man on whose head several heavy planks had fallen. Part of the scalp was torn up, and it was bleeding profusely. I sent my probationer flying to the theatre to ask for some one to come to help, and then I made one policeman put pressure with his finger on an artery on one side of the head and another policeman on the other, while I collected some dressings, forceps, &c. Much to my astonishment, first one policeman fainted and subsided on the floor, and then the other one did the same (the other two had gone outside); then the probationer returned to say the man in the theatre was bad, and they could not spare any one, but some one would come as soon as possible. Just then the police inspector walked in, and his look of astonishment at his two prostrate men was very fine, but he called the other two men to move them, and then he gave me the help I needed, while the probationer and I did what we could to stop the hæmorrhage; it was pretty well subdued by the time the house surgeon got down, but he saw at once it was a bad case, and took the man straight up to the theatre. As soon as he had gone we dosed the two policemen with Mist. Ammonia, but it was a little while before they were fit to return to duty, and then we were just thinking we would begin our much delayed morning's work when, strangely enough, two men were carried in dead, the two stretchers arriving within a few minutes of each other; one was a suicide from the Thames, and the dressers tried artificial respiration for some time, but the poor chap was quite dead; the other was a poor old gentleman who had apparently died of heart failure when hurrying to catch a train.

We saw a great many infectious diseases in the front surgery, and had to keep them in an isolation room till the fever ambulance came to fetch them. I remember one day when we had samples of nearly all the infectious fevers to despatch--first came a case of smallpox, then one of scarlet fever, then one of diphtheria, and there were also cases of measles and chickenpox, but these had to be sent back to their homes. There was quite an outbreak of smallpox just then (I think we had twenty cases in the front surgery in one week), so everybody in the hospital who had not been recently vaccinated had to be done, and we were all very sorry for ourselves for a time.

Another little episode in the front surgery was when a baby took us all by surprise by being born there! We should have sent it on to the Infirmary, but the mother was rather bad, so we had to take them in.

One Sunday evening I was in chapel when I heard some one come to the door, and then the porter came to fetch me, and at the door I found one of the dressers who told me there was a bad compound fracture in the surgery, and the house surgeon would be glad if I would come, as he wanted to give an anæsthetic. When I got there I found a crowd of men all standing round a poor little dog with a badly crushed leg! so we got some suitable splints, and they gave it an anæsthetic and put up the fracture; then they sent word to the male accident ward to get a fracture bed ready for a patient, and the porters were secured to carry it along on a big stretcher. It was in the hospital for some weeks, and got quite well again.

Just before Christmas the Matron was obliged to go home for a time, so once more I was asked to go on duty as assistant matron. Christmas is always a busy time all over the hospital, and in the office (with the Matron away) we had more than enough to do--so many presents to receive and acknowledge and distribute, and many visitors to show round, &c. Then, after Christmas, a good many nurses got ill (some with influenza), and every one seemed to be wanting special nurses at the same time, and all were quite hurt that I could not make new nurses to order.

So I was not sorry when the sister of the nicest ward in the hospital told me that she had been appointed Matron of another hospital (she had been here for years), and as she knew nothing of office work she wanted to ask Matron if she would have her in the office for a few weeks' experience. I thought it would mean that I should go back to the front surgery, and I was quite pleased, but instead of that, Matron wrote to ask me to take over that sister's ward for a couple of months, as she had not got a suitable sister ready to take it permanently (it is always given to one of the seniors here); so I was still more pleased, especially when I found that the pay was at the rate of £10 a year more than for the other wards.

This is an awfully nice ward of thirty-two beds, in two divisions--one for men, and one for women and children. It is chiefly for medical cases, but there is a small theatre attached, and a good many abdominal operations are done; there is also a private ward, to which the surgeons can send any operation cases that need especial attention; and they have special nurses.

In the wards I have a good staff, as it is always considered the most acute ward in the hospital, and I can generally get an extra nurse if I want, so I don't do much actual nursing myself, but there seem to be doctors constantly going round whom I have to attend, and somehow I always seem to be busy.

The longer I am in hospital the more I see how much harder it is to be responsible for other people's work than just for your own, and I can quite understand why so many of the staff nurses much prefer to do all the best part of the nursing themselves than to teach the probationers and let them do it; but it is a wrong principle, as the probationers must be taught, and we must learn to trust others (even when we know we could do things quicker and better ourselves), and to increase the trust just in proportion as we find them worthy of it; that is where the art of the teacher comes in!

XVII