‘I had. I never remember what day it is on nights.’ I calmed down. ‘Any notion whom I’m to special?’
‘We’d six on the D.I.L. (Dangerously Ill) last night. By now we could have six more. Take your pick.’
‘How long do you think I’ll be with you?’
‘Most likely, just tonight. Our Marcus men don’t linger on the brink like your Hope females. They may come in in little pieces, but if the pieces can be stuck together the results usually show inside of their first forty-eight hours. If not, they’re usually dead. But why so incensed? You love specialing.’
‘I do,’ I said, ‘in my own ward and when I can special a patient right through, as I did my classic pneumonia girl in Hope a few weeks ago. What I detest is being a one-night special in a strange ward and then being whisked away. One can’t special anyone without getting fond of ’em. I love fussing over patients. When I have to leave one in mid-air I fuss to myself for days after. That’s why I object strongly to the Office’s plugging me in as an Automatic Nurse for one night!’
Aline laughed. ‘Little Miss Nightingale’s off! I know what, Jo! You’ll just have to sweet-talk your new chum, Old Red, into requesting the Office to leave you in Marcus for more than one night.’
‘Oh, no! I’d forgotten Marcus is one of his wards. I wonder now, is this good or bad?’
Gwenellen thought neither, as if Marcus tonight was anything like Marcus last night Old Red would be far too busy to remember meeting me in the subway.
Aline disagreed. ‘He is the S.S.O., and he did catch you breaking a rule. He won’t forget that. He doesn’t forget things. Look how he’s remembered your aunt. And even though you do look like her, and probably even more like the way she did at our age, I can’t see that being enough to inspire him with over-confidence in you as a special. Face it, Jo, you were a nut to use that subway! Specials aren’t supposed to be nutty. Watch it with him, Jo, and watch it with Humber. She gave me hell when I was her junior in Cas.’
Humber was the name of the Marcus Night Staff Nurse. When we left Aline at Stanley and went on up to Marcus on the floor above I asked Gwenellen how she got along with Humber.
‘I play her by ear, love. She has her dodgy moods. She’s a good nurse. The men like her. They feel safe with her ‒ and she can be quite human.’ She unhooked her cloak collar as we had to wait at the outer door of Marcus whilst two porters wheeled out an empty accident trolley. ‘You’ll get on with Humber, once she gets used to you.’
‘Thanks, chum.’ There was an open red screen across the open door of one of the two small wards. ‘Think that’s for me?’ I asked, following her into the small corridor we called the ward ‘flat’.
‘Ten to one.’ She took me into the nurses’ changing-room.
Staff Nurse Humber was waiting for us. She was about twenty-seven, tall and very slim. She wore glasses with brown-winged frames that suited her pointed face and enhanced the impression she gave of being about to become airborne. ‘So you are here to special our Mr Francis? H’m. From Hope? That’s something.’
I was puzzled. ‘Is he medical, Nurse Humber? In Marcus?’
‘Nurse Dungarvan, this may have slipped your notice, but patients are human beings and not machines to which one can fix tidy little labels. Mr Francis is in Marcus because he was knocked down crossing a road this morning and has a double fracture of the right tib and fib. He was conscious on admission, explained he had felt unwell for the last few days and had intended seeing a doctor today. He wondered if he was getting appendicitis. He has acute lobar pneumonia. I take it you do know the symptoms can be similar?’
‘Yes. Sister Hope told me she’d known a couple of pneumonias opened up by mistake.’
‘Who, with any experience, hasn’t?’ demanded Staff Nurse Humber coldly. She looked me over with an expression that matched her tone. ‘I’ve been told you’ve recently specialed a similar medical case, but as Mr Francis is an accident case in addition to being allergic to antibiotics, personally I would have considered him a case for a trained special. However, as the Office seem to have decided otherwise, let’s get in for the report.’
Sister Marcus gave me a rather warmer welcome. ‘I am most grateful to Hope Ward for sparing you, Nurse Dungarvan. Sit down, my dears.’ She blotted her final entry in her vast, diary-type report book. ‘Another heavy night for you, I’m afraid, Nurse Humber. We’ve been admitting and transferring all day. This weather, of course. Now.’ She sorted some notes. ‘As the general report does not concern Nurse Dungarvan, I’ll deal with her patient first. He is in Small Ward Two. His name is Mr William Charles Francis; age 26; occupation journalist; religion Church of England; next-of-kin father; addresses of both in the Admission Book; admitted to Casualty at 10.20 A.M. ‒’ and she went on to tell us all I had heard from Humber. ‘After his pneumonia had been diagnosed by the Senior Surgical Officer the diagnosis was confirmed at Mr Leland’s request by the Senior Medical Officer,’ Sister added, then broke off to explain to the night junior, a second-year, that this was routine hospital etiquette when a surgical patient produced a medical complaint, or vice versa. The patient then came under both the S.M.O. and S.S.O.
Mr Francis’s fractures had been reduced and set, and a plaster splint applied by the S.S.O. under a local anaesthetic in the ward that afternoon. Sister Marcus said the condition of his injured leg was satisfactory. She regretted she could not say the same about his chest and general condition, and explained why in detail. ‘The major complication,’ she continued, ‘is his total inability to tolerate antibiotics. We have checked with his own doctor. It would be highly unwise to attempt using them, and in consequence we have on our hands what I can only describe as an old-fashioned case of acute lobar pneumonia. In the pre-penicillin and pre-antibiotic days, which none of you will remember, pneumonia was a very dangerous illness.’ Sister looked at me. ‘As you have recently seen for yourself.’
‘Yes, Sister.’
‘Then you will know what is required of you.’ Not that she left it there. She went, point by point, through the medical and nursing treatment. ‘You must particularly encourage him to drink, Nurse Dungarvan. He is too restless for a drip, and fluids are essential. He has found that a little hard to understand.’
Nurse Humber looked up from studying Mr Francis’s oxygen-intake record. ‘Forgive my asking, Sister, but why is he using a mask? Have we run out of tents?’
‘No. We put him in a tent, but he found the sensation of being, as he put it, sealed up so distressing that the idea had to be abandoned. He’s none too happy with a mask, but happier. As the peace of mind of all patients is important, but never so important as in pneumonia, the compromise was essential.’
Humber voiced the thought in my mind. ‘Is he difficult, Sister?’
‘I wouldn’t say that, Nurse Humber. I think he is just an ill and shocked young man with the highly strung temperament of so many artistic people. Very reasonably, he is worried about himself. A vivid imagination can be no help to a sufferer from serious illness, unless we can help that sufferer to use his imagination as an ally.’ Sister turned to me once more. ‘That’ll be another of your jobs, Nurse Dungarvan. Keep him calm, cheerful, and above all convinced he can recover. Staff Nurse Humber will give you all the advice and assistance you need. Throughout tonight you are not to leave your patient unless you are properly relieved. If you want anything, ring. And before you leave us I want you all to hear what the Senior Medical Officer said to me half an hour ago. He said, “Sister, that boy has got to run his course to crisis, and whether he survives or not depends not on myself or on any other member of the medical staff of this hospital. His life hangs on two things ‒ his own will to live and good nursing”.’ Sister Marcus paused for a few seconds. ‘All right, Nurse Dungarvan. You may leave us.’
Humber shot me a worried glance. Suddenly she looked older than twenty-seven. I knew how she felt. That girl in Hope had recovered, but the night before her crisis she nearly died. As I walked out of the ward and round
the red screen I felt as old as Humber and as worried as she was about my not yet having been fully trained. It was one thing to talk tritely about holding life in our hands; it was a very different matter to find oneself on the point of doing just that. Momentarily, I was dead scared. Then I adjusted the red screen behind me and went into Small Ward Two.
Chapter Two
A VERY SPECIAL PATIENT
Mr Francis was asleep. His day special, a girl called Daisy Yates, was taking his pulse. She was a fourth-year, already an S.R.N., and due to take Hospital Finals shortly. We had worked together in a couple of other wards. She acknowledged this with a raised thumb, but when she showed me the assortment of charts on the bed-table pushed against the wall she gave a thumbs-down over his fluid-intake. I mouthed, ‘I’ve been warned,’ and we changed over without uttering a word.
He was on a fifteen-minute pulse and respiration chart. I took his pulse again directly I was alone. It was as she had recorded. His skin was dry and hot, his breathing rapid and jerky. Occasionally, on expiring, he gave a queer little grunt that I did not like. At least he only grunted occasionally. I had heard those grunts before with every expiratory breath. Yet he looked much worse than my Hope girl at this same stage, probably owing to the shock of his accident. He had been sedated and was propped in a sitting position with his plastered leg stretched out under a large bed-cradle. The plaster was quick-drying and only slightly damp. The sickly-sweet smell of plaster and ether hung in the air and struck a false note. It was like looking at one of those pictures in a children’s book in which there was a glaringly obvious deliberate mistake. Marcus Small Ward Two had turned acute medical, but it smelt like a plaster theatre.
I checked the oxygen. His mask fitted well, the valve worked properly, the large cylinder in use was two-thirds full. A spare full cylinder stood against the wall behind his bed. In our medical blocks oxygen was laid on in pipelines, but as surgical patients seldom needed continuous oxygen for long periods, the surgical side still used cylinders.
I looked at his plastered leg. His toes were warm and a good colour, and there was no sign of swelling above or below the plaster. I stood looking him over for about a minute and then went round the room.
An extra bed-table had been brought in. It was as lined with trays as the other table was with charts. I examined them one by one ‒ drinks, thermometer, stethoscope, blood-pressure machine, plaster cut-down setting, emergency transfusion setting in a sealed tin, emergency tracheotomy setting in another, emergency hypodermic setting on the final sterile-towel-covered tray. I looked at each phial of heart stimulant in turn, the files, the needles in their sterile jar. If any of those emergency settings were needed they would be needed in a hurry, and it was the special nurse’s job to know where everything was. If anything was missing it was the special’s responsibility to ask for it, and ask fast.
On her way off, Sister Marcus came in with Humber. Shortly after Humber returned alone and toured the room, as I had done. Once satisfied, she took his pulse again, then watched him for a while. She said very quietly, ‘I’m glad he’s so thin,’ and took herself off.
His sleep was restless. He kept twisting himself on to the side of his affected lung, but did not wake when I altered his position. His hair was dark and long enough to fall over his eyebrows when it dropped forward. When I pushed it back, as it made him look so hot, the skin of his forehead was burning.
A spasm of coughing woke him. His cough was short and harsh, painful for him and to hear. He stared at me blankly as I held him forward until the spasm passed. ‘Another new face,’ he muttered when back against his pillows. ‘Hello.’
‘Hello, Mr Francis.’ I explained about my taking over from his day nurse. ‘I’m Nurse Dungarvan.’
‘Pretty name.’ He breathed carefully. ‘Irish?’
‘Half.’ I shook down the thermometer. ‘My mother’s English.’
His eyes were brown and dulled by drugs, his temperature, and anxiety. When the thermometer was out he wanted to know his temperature.
‘Up a bit.’
‘Don’t be so bloody silly, Nurse! Not being a moron’ ‒ he coughed ‒ ‘I can tell when I’ve got a fever. I want to know how high I’ve gone. I don’t want to be treated as if I’m three years old and backward at that! What the devil is it?’
I hesitated. I was going to have to manage him, and whether I was able to do that successfully depended very much on how I managed this moment. I could not possibly tell him the truth, as that would scare the daylights out of him. I did not want to lie, as I was sure he would see through that and in future mistrust me. Nor could I let him bully me. The consequences to any patient-nurse relationship once a nurse allowed that could be as disastrous, if more excusable, as when bullying took place the other way round.
I took refuge in the truth, if not with the truth he wanted. It had worked with other patients. I just hoped it would with him.
‘Look,’ I said, ‘I do see your point, and I’m not trying to talk down to you, but if I went round telling you, or any other patient, their temperatures my bosses would kill me. I know it’s your temperature. It’s also my neck.’
‘Truly? You’re not just stalling?’
‘No. I’m being honest.’
He blinked as he thought this over. He had long and thick eyelashes. ‘Point taken. Are you going to stay with me? Like that other nurse, today?’
‘Yes.’
‘All night? Does that mean I’m very ill?’
I hedged that one. ‘It’s more because you’re in this little room by yourself. You’re in here because there’s no room in the main ward. Incidentally, in there they’ve got a senior staff nurse to look after them, plus two other nurses. You’ve just got me, and I’m only a third-year student nurse.’
‘That means I’m not too bad?’
‘Indeed you’re not. You’re doing fine.’
He said slowly, ‘I rather think I am.’ His eyes suddenly smiled. ‘If all I have to do to get a girl with your looks to spend a night with me is bust a leg’ ‒ he stopped for breath ‒ ‘soon as I’m out of here I’m busting the other.’
‘A trifle drastic, Mr Francis, but a new approach. Now, how about a little drink?’
‘Christ! Don’t you start that! I’m not thirsty. Just hot.’
‘A drink’ll help cool you down.’
‘How?’
That was an answer I could give in medical detail, and so I did.
‘See here,’ he protested when I had finished, ‘there’s nothing wrong with my kidneys.’
‘There will be, if you don’t drink.’ I slid a hand beneath his head and raised the drinking-feeder to his lips. ‘Be a pal, Mr Francis. If you won’t consider your kidneys, just consider my neck.’
He looked up. Our faces, of necessity, were close. ‘That’s no hardship. You’ve a beautiful neck ‒ amongst other things. You realize you are taking an unfair advantage?’
‘It saddens me deeply, Mr Francis. Ready?’ I tilted the feeder. ‘Cheers.’
It took a little time, but he drank the lot and went back to sleep. He woke from time to time and on each occasion drank a little more. Humber kept reappearing and checking his charts. After a couple of hours she stopped scowling over his fluid-intake.
The Senior Medical Officer came in with the Thoracic Registrar. The Night Superintendent with Humber. A junior night sister alone. The General Surgical Theatre was working late. It was after midnight before Tom Lofthouse, the G.S. houseman and Gwenellen’s fiancé, was the first of the surgeons to arrive in Marcus for his night round. Humber brought him into the Small Ward to look at my patient’s injured leg. Tom caught my eye behind her back and winked to acknowledge my presence on alien territory.
Mr Francis was awake again. He saw Tom’s wink. When we were alone he asked if the fair doctor in the short white coat was my boyfriend.
‘No. He’s a great friend engaged to another great friend.’
‘How cosy!’ He yawned. ‘You engaged
to one of his great friends?’ I shook my head. ‘Why not? Don’t you like doctors?’
He was very drowsy, and as I had no intention of letting him wake himself up with a conversation on my private life or anything else, I said I did not believe in mixing business and pleasure, and, as I hoped, the cliche put him to sleep.
Behind the screen Marcus settled into the night. The occasional murmur of a man’s voice, the swish of a nurse’s skirt, the creak of bed-springs, the chink of slung-weights shifting, the clink of a glass being replaced on a locker-top, floated in over the screen. I was conscious of these familiar night sounds without actually listening to them. I was too busy listening to my man’s breathing. Those expiratory grunts were slowly increasing. Sometimes he winced in sleep. I found myself wincing with him.
Special nursing affected most nurses I knew the way it did me. One arrived at the bedside of a total stranger, and inside of a few hours that stranger became not merely the most important person in the world, but one’s entire world. Mr William Charles Francis was now ‘my man’ to me, and ‘Dungarvan’s man’ to the other Marcus nurses.
That even included Humber. She sent Gwenellen to sit with him, because she wanted to tell me about a telephone call from General Francis.
We talked in the flat. ‘Your man’s father, Dungarvan. This is the second time he’s rung tonight. Night Super took the first call, but I’ve just been speaking to him, and you’d better have the full picture.’ She went on to explain that General Francis was a widower, and semi-invalid. He lived in Devon. He had made arrangements to drive up to London tomorrow. He had suggested coming tonight, but Humber had explained that that was not necessary. ‘I offered him a bed in our relatives’ hostel, but he prefers to stay at his club, and, as he has this spinal arthritis, is bringing his own car and the man who looks after him. I think he’ll probably be more comfortable in his club. He sounded very nice.’
‘Any others in the family to be contacted, Nurse?’
‘No. The only other son, the younger one, is in the Army in Hong Kong. As your man is single and hasn’t given us any name apart from his father’s, I take it he’s unattached. Or doesn’t want his girlfriend worried ‒ though that I doubt.’
Hospital Circles Page 2
