Chapter 3

If the amateur nurse has been doing something actually wrong for the patient, do not tell her so. She did the best she knew how; but say, as pleasantly as you can, "I think perhaps _this_ would make our patient more comfortable," or "The doctor thinks such and such things are not now necessary, and it would be better to do this way." Then you can do what you know to be right, and not hurt the feelings of the one who has preceded you, and, feeling your way carefully, have everything just as it ought to be, and no one's feelings will be hurt, and no one will feel that you are looking down upon their ignorance; and here I would say that in your little confidential talks with the doctor, you could ask him to say a word to the family if they persist in doing what you know to be wrong. Ask him to give you orders before some of them, and that will set _you_ straight in a moment.

With tact, that most invaluable gift, you can get on with _almost_ every one, and when you find that there is no such thing as making friends with the family, you can tell the doctor, and he will let you go; but such places are very rare. Let all see that you are thoroughly interested in your patient, and do not hesitate to perform any little kindness that falls in your way for the rest of the family, and you will win all their hearts without a struggle.

When you go for your rest, be sure to leave carefully written directions for the one who is to take your place, just as you do when in charge of a hospital ward, you leave your orders written out when you go for your "off duty." Show her how to keep the sick-room record, and be sure she understands it all before you leave.

As for the visitors, they are often difficult to manage, and here again you must have the family help you. Of course _no_ visitors are allowed until the doctor gives permission. So far all is easy, but when they are admitted you will do well to make a little plan with the family. Tell them the patient may be seen at such an hour. Perhaps between eleven and twelve, perhaps between two and three, just as you consider her brighter in the morning or afternoon. Ask them who of the first and dearest friends is the quietest and most discreet, and then say that if they will kindly arrange for one visitor only to come each day, it would be so much better for the convalescent. The friends can always do this and they never object. They tell Mrs. Jones to come on Monday at two, and stay just fifteen minutes. On Tuesday Mrs. Smith can come, and so on, until by the end of the week the arrangement ceases to cause any comment, and soon, if all goes well, and the convalescence goes on without interruption, _your_ rules and extreme care can be relaxed to suit the patient's own fancy.

Always carefully note if any visitor tires your patient, and manage so as not to let her come again until the sick one has more strength. It is better, I think, to sit in an adjoining room when your patient has a visitor. This gives you a chance to come into the room when the person has stayed long enough, and generally your entrance tells her very plainly that she ought to go, and she departs without you saying a word. If she does not, you will have to tell her that the doctor is very particular about not letting the patient talk too much, etc., etc., and get her out in that way. Be careful, when the visitor has gone, not to sit down and talk at length yourself. Give the patient a little nourishment, turn over her pillows, and if she seems at all wearied make her comfortable for a nap and let her sleep.

As to the servants they require pretty careful handling. Above all things, keep on the right side of the _cook_. If you have to go to the kitchen to do any of the cooking, do not make a _mess_, or, if you do, don't run off upstairs and leave it. Gather up your utensils and put them into the sink, and let the water run over them, and ask for the dishcloth: and if you do it pleasantly, the cook will probably tell you to "Niver need thim things," and you will thankfully obey her. If you really cannot stop to make all tidy after your cooking, you can say, "I'm sorry to make you extra work with these dishes, but I must hurry back upstairs." Some such little speech, with a pleasant smile, will make all things easy for you below stairs, and for the sake of all the friction it will save you, it is well worth the trouble. Often the cook will be glad to do the cooking if you tell her how; be careful to tell her, if it is eaten and enjoyed; and never let her know if it is rejected. Get rid of it upstairs by some contrivance, and be sure not to order that dish again. In many cases of course the cook will know all the little dishes the sick one will fancy, and you will have very little to do with her. Such instances are somewhat rare, and very delightful when they occur.

If there is much extra washing, you may have to use much diplomacy as regards the laundress; and if it is very disgusting washing, it is well to have a large pail, with a cover, upstairs. Thoroughly disinfect the clothes before you send them to the washing, as the odors are often sickening, and the laundress, like other servants, is very much afraid, usually, of clothing from a sick-bed. Carry or send the clothes to the washing as soon as possible after removing them from the bed; never, on any account, allow them to remain in the room.

The nurse cannot be too careful as to the amount of clothes she sends to the laundry. She should of course keep herself and the patient scrupulously clean; but she must reflect that private families do not have an unlimited store of towels and sheets, and if she is extravagant in this matter it will seriously detract from her acceptability.

In concluding, let me remind you that all these hints are intended for nurses going from one strange place to another, as you would in nursing fevers, or short surgical cases. Nurses who have chronic cases need none of these rules. They fall into a routine, and if they are detained in the family for any length of time, that shows that their work and methods are right, as far as that patient and family are concerned. But let them be careful when at last they leave the case, and go amongst strangers. The ways of one family are not the ways of another, and they must exercise much discretion to accommodate themselves to the new environment.

V

GENERAL REMARKS ON FOODS AND FEEDING

Always have all food presented to an invalid as tempting as possible. Use pretty china and glass, if you are permitted to do so, yet not the very finest the house affords; that might make the patient nervous lest some evil befall it. Absolutely clean napkins and tray cloths, a few green leaves about the plate, a rose on the tray; the chop or piece of chicken, the bird or the piece of steak ornamented with sprigs of parsley, the cold things really cold, and the hot ones _hot_, these are necessities of invalid's feeding, that mark the nurse who has a proper appreciation of a sick person's delicate sensibilities. Have all plates, cups and saucers _hot_, when they are for the reception of hot toast, coffee, tea, etc. Hot water plates are very convenient, and easily procured at any large china shop; but if they cannot be found, put the hot plate containing the chop over a bowl of boiling water, and cover with a hot saucer, fold a napkin around the baked potato, and you can carry the tray containing the dinner through cold halls and up staircases and it will arrive at your patient's room _hot._ Be careful not to fill the bowl so full of hot water that it will spill. Never fill a cup so full that it will spill its contents over into the saucer, it makes a disgusting looking _mess._ Have all fruit _cold,_ oranges and grapes especially. Always look over a bunch of grapes and cut off the soft ones before you hand them to a patient. If you have foreign or California grapes, hold them for a moment under the cold water faucet and let the water run through the bunch, and all the cork dust will then be washed out.

If you peel and quarter an orange for your patient never let her see you do it, unless you are perfectly sure you will not get your hands covered with juice. Wash your hands before you bring it to be eaten.

Be careful not to have any suspicion of grease about the beef tea, broths, etc. A quick and easy way to remove all grease, is to fill a cup or bowl _brimming_ full, let it stand a few moments that the grease may rise to the top, tip the cup a very little to one side, and the grease, to the last atom, will flow over the side of the cup; pour your broth carefully into a clean hot cup, and serve. Beef juice is more palatable with a little very brown toast.

Remember, that an invalid hardly ever likes any food made sweet. No matter what the taste may be in health, in sickness, sweet things are nauseous; for this reason ice cream bought at confectioners' is often rejected. Salt also must be used with caution, if the mouth and lips are tender, as is often the case; use the salt sparingly in all broths, etc.

If your patient cannot take milk, when, as in typhoid fever, the doctor wishes the diet to be wholly or for the most part of milk, try at first to remove the thick, bad taste by giving a little pure water or carbonic acid water after it. If that will not do, mix the carbonic acid water with it, and have both nice and cold. If a glass of milk is too much (and it will be in nine cases out of ten, especially if it is cold), give half a glass; if that is still too much, give quarter of a glass, or put more water with it. Never repeat a dose (of food) if it nauseates the patient. Make some change in quantity or quality, and you will, if you watch carefully, find out the right proportions.

A person lying flat down in bed cannot, of course, drink from a glass or cup, and a feeding cup is apt, by pouring too freely, to cause choking. A bent glass tube is the best arrangement, the patient can drink easily through this, and can regulate by sucking, the rapidity with which the food is taken. The tube should be cleaned immediately after each using, and if any beef tea or other food cannot be dislodged by letting water run through it, pass a string with a knot tied in it, through. Make the knot big enough to touch all sides of the tube, have it thoroughly wet, and the cleansing will be easily and quickly accomplished. If a patient prefers drinking from a glass, and can be raised in bed, always lay a napkin under the chin before you give the drink, and on no account have the glass or cup more than half full, if you do, it will surely spill.

In giving medicine that tastes very bitter or unpleasant in any way, bring, at the _same time_ with the medicine, some water, milk, or whatever may be preferred, to take after it. Also a napkin to wipe the lips, especially if the patient be a man.

Always keep milk, beef tea, etc., _covered_ in the refrigerator, and, if you can, see that this is cleaned every day. But this might cause the cook to feel aggrieved, so I put it as a suggestion merely. But if the refrigerator has a _smell,_ and the cook seems touchy, the milk, etc., better be kept upstairs on some sheltered window-ledge, and carefully covered.

If you have your own little refrigerator upstairs, see to it that it is cleaned _every_ day. Never put away anything in tin pails; always use earthen or china bowls or pitchers.

BEEF TEA.

Beef from the round, finely chopped and free from fat. Proportions, 1 lb. beef to 1 pint of water, cold. Let the beef soak in the water, stirring occasionally, for two hours; then put it on the stove and heat it until the red color disappears; never boil it. Skim off all grease, salt to taste.

BEEF JUICE.

Round steak cut an inch thick; slightly broil like beefsteak for the table, cut into squares of an inch, squeeze in a lemon squeezer, skim carefully and salt. Serve either very cold, or place the cup containing the juice in a bowl of boiling water, stir carefully, and as soon as the juice is warm serve. If left a moment too long it is spoiled, as it curdles. One pound of beef makes an after dinner coffee cup almost full of juice.

BEEF TEA IN A BOTTLE.

Put into a Mason's preserve jar, tightly corked, one pound of beef chopped as for ordinary beef tea. Put this into a kettle of cold water, with a saucer on the bottom, let it come slowly to a boil and boil for an hour. Take out of the bottle and squeeze the beef.

SCRAPED BEEF.

Take a piece of lean round steak, scrape with the edge of a spoon until the place scraped has no more meat on the surface, but only the white fibre, cut this off with a sharp knife, exposing once more a fresh surface. Season, and spread raw on bread and butter, or make into little cakes and broil slightly, according to the doctor's orders, or your patient's taste.

MUTTON BROTH.

Mutton from the neck. Proportions, 1 lb. of mutton to 1 quart of water, put the mutton and the water (cold) on the back of the stove, let it come slowly to a boil, boil until the meat is ready to fall from the bones. After straining out all the meat etc. add one tablespoonful of rice or barley. Simmer half an hour after adding rice or barley.

CLAM BROTH. NO. 1.

Take 1 qt. clams. Strain off the juice and chop the clams fine, return clams to the juice and simmer one hour. Put on to scald as much milk as juice. Strain out the clams, thicken with a little corn starch, making about as thick as cream, pour juice into a bowl and add the milk.

CLAM BROTH. NO. 2.

Same as above, only cut off the hard part of the clams, chop the soft parts and leave them in the broth. For convalescents.

CLAM BROTH. NO. 3.

Take little neck clams unopened, wash them very clean with a brush. Place them on the top of the stove in a clean dry pan, and when the shells open take them off, remove the clams and pour the juice into a cup. To be served hot. If it is too strong, add a little boiling water. This is for very sick people; give only a teaspoonful at a time. It sometimes corrects nausea.

CHICKEN BROTH.

A fowl, not too young, cut in pieces, 1 qt. water to 1 lb. fowl. Put it on the stove in cold water, let it heat slowly, then boil gently until the meat is ready to fall from the bones, strain, skim and add rice, boil once more for 1/2 hour. Salt to taste. Serve with toast or hot crackers.

OYSTER BROTH.

Equal quantities of juice and milk, put each in separate vessels on the stove; when the juice comes to the boil, skim and slightly thicken, pour in the milk boiling hot, add the oysters one by one, let them remain on the stove about five minutes, or until the beards begin to curl, and they are no longer slippery. Serve with crackers heated very hot.

OYSTERS BROILED.

Dry the oysters, large ones are best, in a towel, have a piece of toast slightly buttered on a hot plate, near, pour over this a little hot oyster juice, not enough to make the toast wet through. Arrange the oysters on a fine buttered broiler, cook over a brisk fire like steak, until the beards curl. Turn them often. It takes about five minutes. Arrange them on the toast, add a little salt and a very little butter, serve very hot.

BROILED CHICKEN.

The chicken must be young, split down the back. Lay on the gridiron and broil evenly, turning frequently. Serve on a piece of buttered toast, salt and slightly butter the chicken. A little parsley garnishes the dish prettily.

All birds to be broiled should be split down the back and broiled evenly, laid on thin toast and served hot.

BEEF STEAK.

Steak must be cut 3/4 inch thick, and evenly broiled, rare, unless particularly requested to do otherwise. Be careful not to smoke it; the grease dropping into the fire may make trouble in this way.

OATMEAL GRUEL.

Take two large iron tablespoonfuls of oatmeal freshly cooked for breakfast, add one cup of boiling water, slowly stirring all the time, then add an equal quantity of milk. Let all boil for ten minutes, and strain through a fine wire sieve. If you have no cooked oatmeal put 1/2 cup raw oatmeal in a double boiler with two cups of boiling water and cook for two hours, then proceed as above. It makes the gruel richer to add all milk, or 1-1/2 cups of milk and 1 cup of cream. Be sure not to forget the salt. Never put any sugar in unless requested to do it by the patient.

KOUMYSS.

Dissolve a third of a cake of compressed yeast (Fleischmann's) in a little warm water (not hot). Take a quart of milk fresh from the cow, or warmed to blood heat, add to it a tablespoonful of sugar, and the dissolved yeast. Put the mixture in beer bottles with patent stoppers, fill to the neck, cork, and let them stand for twelve hours where the temperature is about 68 degrees or 70 degrees, then put the bottles on ice, upside down.

MILK PUNCH.

One glass of milk, 1 or 2 tablespoonfuls of brandy, 2 teaspoons of sugar.

Shake well or beat with an eggbeater. Give cold. Have patient take slowly.

EGG-NOG.

One egg, half glass of milk, 2 teaspoons of sugar, 2 teaspoons of sherry or brandy, ice. Beat the yolk of egg in a glass, add the sugar and beat, then a little milk, continue beating, then four or five pieces of ice about as big as a hickory nut; add brandy-- regulate to the taste of your patient--add rest of milk; beat whites of eggs and add all but a teaspoonful with which garnish the top. It should make a glass brimming full. Have a spoon with which to eat it.

EGG LEMONADE.

One egg, one-half a lemon, 2 teaspoonfuls of sugar, beat the white and yolk separately as for egg-nog; add the sugar to the yolk, then the lemon juice, then the ice, lastly the white beaten to a stiff froth.

WINE WHEY.

One pint of boiling milk, one-half pint sherry; add sherry to the milk while scalding hot; stir a moment until the curd gathers; strain through a fine muslin, sweeten. To be taken cold. This takes a little practice to gather the curd as it should be done.

POACHED EGGS.

The best way of cooking for an invalid. Slip the egg, previously broken into a saucer (the fresher the egg the better), carefully into salted water which is boiling in a frying pan, then immediately set the pan at the side of the stove so that the water does not boil, keep it there for about five minutes. Let the water be about two inches deep in the iron frying pan. Each egg must be broken separately and slipped carefully into the water. When cooked so that the white is firm but jelly like, no part being raw or hard, take it out with a skimmer and slip it on a piece of thin buttered toast, sprinkle a little salt and pepper on top, serve immediately. Garnish with parsley.

SCRAMBLED EGGS.

Beat two eggs until thoroughly mixed, add two tablespoonfuls of milk, salt and pepper. Pour into a very hot frying pan, buttered, and stir constantly for about two minutes. Pour over buttered toast.

SHIRRED EGGS.

Heat the shirring cup very hot. Put in a piece of butter as big as a large pea. Shake it about and break in the egg. Let it remain on the stove a few moments and serve in the shirring cup. Sprinkle salt and pepper on it.

OMELETTE.

Beat very stiff two eggs, whites and yolks separately, add two tablespoonfuls of milk and a little salt. Pour carefully into a small frying pan, _hot_ and buttered. As soon as the egg is _set_, slip a knife under one side and fold one side over the other. Slip on a piece of toast and serve at once. A little finely minced ham or parsley flavors it very well.

RENNET.

One pint of milk slightly warmed and sweetened and flavored, add one large teaspoon of liquid rennet. Stir for a moment and set it in a refrigerator. To be eaten with sugar and cream.

BOILED CUSTARD.

One pint of milk and 2 eggs. Beat the eggs, add the milk heated almost to the boiling point. Stir in 2 tablespoonfuls of sugar. Return to the double boiler, and cook for about 3 minutes, stirring gently all the time. When done it will be about as thick as cream. Be careful not to let it cook too much as it will "separate" and be spoiled.

BAKED CUSTARD.

Same ingredients and proportions as for boiled custard, only let milk be cold. Pour into custard cups. Stand these in a dripping pan half full of warm water and bake in a pretty hot oven. Watch carefully, bake 15 minutes.

THIN BREAD AND BUTTER.

Have a loaf of good home-made bread, yesterday's baking, cut off the crust, then butter the loaf and cut the slice in this way, buttering first and cutting afterwards. The slice can be made _very_ thin and dainty, and the thinner it is, the better. A patient will sometimes relish this when tired of all kinds of toast or crackers.

VI

THE NURSE AS RELATING TO HER OWN TRAINING SCHOOL AND TO HER FELLOW NURSES

Always be loyal to your own school and hospital. It may not have been in every respect perfect; but it is not necessary to tell strangers of its imperfections: probably those in authority are just as sensible of its short-comings as you are, and perhaps they work harder than you do to right its wrong; in any case it does no good to tell others of the things you disapproved. It may indeed be that your criticism is one-sided and unfair, that the very rules you hated and found hard to keep are the wisest ones, and, if you let strangers see that you disapprove of these wise regulations, the opinion they will form of your intelligence will certainly not be flattering to you.

When you meet other nurses in your work, as you are sure to do, and when you compare your school with the one the other nurse came from, try to realize that the other school is neither wholly above nor wholly below your own; each has probably its own merits and its own drawbacks. You should not tell the other nurse any of your own school's shortcomings, any sooner than you would tell them to any other stranger; be loyal everywhere to the place where you were fitted for your work.

Never tell revolting hospital stories to your patients. Some people have the most morbid wish to hear dreadful details. I remember a patient of mine, years ago, asking me in all good faith to tell her the most horrible thing I had ever seen in all my hospital experience. I asked her why she wished to hear such things, and after some reflection she acknowledged that it was a foolish, morbid curiosity. It is best to keep the dreadful side entirely out of sight; there are plenty of bright, interesting, pleasant things always occurring; tell of these. Tell of the cunning little babies in the lying-in ward, the absurd little black ones, the fat little German and Swede babies. Tell of the surly drunken men that come, and how a week of cleanliness in bed, with a broken leg, or it may be a cracked skull, will change them into quiet, polite, pleasant patients; and how, later, they will take their turn at washing dishes, with a docility that would make their wives stupid with amazement. All such matters (and the more you try to think of them, the more you will be able to recall) will amuse and really edify your patient, many of whom think of a hospital only as a place of terror.

Never gossip about your sister nurses; of the stupidity of one, the untidiness of another, or the overbearing nature of the third. It can do no good, and it lowers you in the estimation of every one who hears you talk.

As for your duties to each other, I would have you always observe the same punctilious etiquette outside that you do in the hospital. When you are called to assist another nurse, remember that _she_ is the head nurse; the case is hers. She gives directions, and you follow them; be sure you do it faithfully. If you have some one to assist _you_, be sure you arrange for her rest and exercise, and that you leave intelligently written orders when you go for your own rest.