"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
GENERAL HOSPITAL, LONDON,
_December 1896_.
I think I last wrote when I had just taken charge of C. Ward for two
months.
I had a most interesting time there, and was quite sorry to give it up,
but it was hard work. Unlike the other wards, that "take in" new cases
for a week and then have a rest, C. is always "taking in," as the men in
charge see every new case that comes up to the hospital (except
accidents), and they can take them in if they like, as long as there are
any beds empty in the ward; and if they don't think it is a particularly
interesting case, it is passed on to the house surgeons or house
physicians for the other wards; but, of course, they try their best to
get all the most interesting cases for themselves; consequently the
sister is never free to go out with any confidence that no new cases can
be landed in while she is away; and when you do go out you generally
find on your return that something has happened that makes you wish you
had never gone!
Still I learnt a great deal in my time in that ward, and I enjoyed it.
The physicians' talks with the students over these "selected cases" were
most instructive.
Soon after I took charge we had a run of tracheotomies; the first was a
dear, fat baby of thirteen months, but it had diphtheria very badly, and
was not a hopeful case from the first; not many hours after it was
operated upon another came in--a sweet little boy of three called
"Alex." He was much relieved by the operation, and got on so well; but
the poor baby ran a temperature of 106° all through the second day, and
died late that evening with a temperature of 108°, in spite of all we
could do for it. I believe we were much more cut up about losing it than
the mother was; she did not seem to mind a bit, and apparently had made
all her plans for the funeral beforehand--and it was such a pretty baby
too!
The special nurses I had for these tracheotomies had never nursed one
before, so you can imagine I could not leave them alone much, and was
thankful I had had a good many to nurse when I was a lady pupil.
We had one very curious case. A young man was brought in unconscious one
afternoon about 2 P.M.; a little after five he got worse, and his
respiration suddenly stopped, the pulse went on steadily, so they did
artificial respiration; this went on till 9.30 P.M., and then they
decided to trephine, thinking it must be a cerebral tumour pressing on
the brain; of course no anæsthetic was necessary, as the poor man showed
no sign of life except that the pulse was beating; they could not find
any tumour, so he was put back to bed, and the men went on doing
artificial respiration all through the night in turns, until the pulse
suddenly stopped at 9.15 A.M., sixteen hours after the respiration had
ceased--a very strange case.
We often had rushing days, when it seemed impossible to make time for
meals, and scarcely time to breathe. I remember one day especially, when
we took in seven new cases, two of them, curiously enough, men from
quite different districts, who had both taken oxalic acid with a view
to suicide; one was an old man who was very bad for a day or two, and
then seemed to be getting better, but died suddenly one night from heart
failure; and the other was a poor young fellow of thirty, who had been
waiter in one shop for eight years, and was then turned off by a new
manager and replaced by a German lad. He had a wretched wife who drank,
and she took away his clothes and then disappeared; so we had to rig him
up in a suit when he went off; one of the other patients gave me five
shillings for him, and he asked me to keep it till he had been before
the magistrates, as he thought he would be sent to prison, but he came
back after his appearance in the police courts to tell me he had been
let off with a caution, and he thought his old master would take him
back; such a nice, quiet-mannered man, and most anxious to do anything
to help the nurses in their work, or to wait on the other patients, and
they all liked him.
The same day one of the house surgeons was admitted with a badly
poisoned arm, and a friend of one of the students with typhoid fever; he
had it very badly and caused us much anxiety, but pulled through all
right in the end.
After this spell in C. Ward I expected to return to my front surgery,
but instead I was offered in March (and gladly accepted) the post of
Night Sister, and that is what I have been doing ever since, except for
an interval for my summer holiday, and also for a few weeks when I took
charge of a large male medical ward while the sister had her holiday.
Being Night Sister here means plenty of running about, and plenty of
responsibility, but it also means better pay than Ward Sister, so that
suited me all right.
They are talking of having two night sisters soon--one medical and one
surgical--and there would be plenty of work for two, as we have a good
deal of theatre work in the night, and sometimes I cannot help being
worried when I am kept long in the theatre with urgent cases, and I know
there are bad cases over in the medical buildings (sometimes with only
rather junior nurses in charge of them), and I can't get round to visit
them.
I have charge of about six hundred beds, and they are divided into
twenty-one wards (of course nurses in each ward and two nurses in the
large wards); I have to go all round three times every night, and run in
much oftener to see any bad cases, and the nurses send for me in any
difficulty; there is a slate in my office for messages, and when I
return after my rounds I often find two or three messages, "Please come
at once to P."; "Please come to N.--urgent," and so on, and I have to
fly to whichever I think is likely to be the most urgent.
The morning round always takes the longest, as all the patients are then
awake, and I have to say good morning to them all, and remember to ask
after their particular aches and pains, and it is not very easy to
remember what is the matter with them all, though I know very well all
the details about those who are very ill and have much done for them in
the night.
There is one place I don't enjoy visiting, and that is the strong room
at the top of the surgical buildings. Lately we seem to have had so many
men who go off their heads (generally from drink), and if they are left
in the wards they disturb the other patients so much that it is better
for them to be moved, and then they have male attendants up there; but
these male attendants are not members of our regular staff (I wish they
were), and I never feel that I quite know their capabilities, or how
much I can trust them, and more than once I have found them asleep; so I
have to go up very often when any patient is bad there.
I remember one night we had a very lively time of rushing about. We
began with a man who had cut his throat--not very bad, but he had to go
up to the theatre; then a lady who had taken three ounces of laudanum,
and the doctors had to keep her walking up and down the corridor, with a
weary porter on each side of her, for six hours before they thought it
safe to let her turn into a bed; then I was called to a poor man in Ward
P., who got worse, and died rather suddenly--a phthisis case; next a
tracheotomy came in, and had to be done at once, and while we were all
busy with it a baby was born in Ward D.; but the day sister had to be
called to attend to that, as I was mixed up with the diphtheria case,
and could not go near a confinement; then a fractured femur came in, and
next an acute pneumonia--rather delirious. In the intervals of receiving
these new cases and sorting them to the different wards we had to brew
strong coffee and administer it to the lady who had taken poison, and
provide refreshments for the porters who were minding her. In the early
morning she was allowed to go to bed and to sleep; she recovered very
soon, and I don't think she will do it again!
I joined the Royal National Pension Fund for Nurses a few months ago; it
seems to be a good thing, and if I can only keep up the premiums I shall
have the noble pension of about £20 or so when I am fifty; it will keep
me in extras when I retire to the workhouse, as I am certain no one can
go on nursing for a great many years at the pace we have to go in
hospital.
Just now I am having a rest (and another sister is rushing about on
night duty), as I have been warded for the past fortnight, and in a few
days I hope to go home for a change.