The War Nurse

by Tracey Enerson Wood

  Dr. Murphy nodded. “Fine work. And you?” He pointed to Dorothy, a tall, lanky, highly experienced nurse, who I was surprised hadn’t volunteered her report first.

  Dorothy cleared her throat and studied her note card, scratching her neck and hesitating a beat too long.

  “Something wrong?” I asked gently.

  “It says I’ve come upon a soldier in a field with a mouth and jaw injury. Due to the bleeding and swelling, he can no longer breathe through his mouth or nose.”

  “And what do you do?” Dr. Murphy rocked back on his heels while the other nurses paid rapt attention.

  “Well, I… He needs a tracheotomy.”

  “And I repeat, what do you do?” He began to pace. “He’s gasping his last breath. His eyes bug out, pleading with you.”

  “I’ve seen the procedure a hundred times.”

  “You have a sharp knife and a syringe. What do you do?”

  “I… It’s just a small incision.”

  “He’s lost consciousness, nurse. There is no one else around. It’s up to you. Can you save him?”

  The nurses covered their mouths, waiting for her answer.

  “Between the ribs of the trachea. The syringe could be used to suction blood or as an airway. But…”

  “Yes, nurse?” Dr. Murphy stopped his pacing and stood in front of her, hands on hips. “He still can’t breathe. Do you perform a tracheotomy and save his life?”

  “No, Doctor.” Dorothy stared at her shoes and wiped her eyes with the back of her hand.

  The room shuddered with a collective gasp.

  “Explain,” he said.

  “I am not qualified to perform the procedure. There are limits to what we can do, and we must accept them. To do otherwise would open a host of new problems.”

  “As sad and frustrating as this may be, she is right.” He looked around at the bewildered nurses. “We medical professionals must adhere to the limits of our training and licensed authority. To do otherwise would create a chaotic system with no standards and unreasonable expectations.”

  “Thank you, Dr. Murphy.” To the nurses, I said, “We will discuss further tomorrow. You are dismissed for today.”

  The nurses gathered their books and notes, and they and the volunteer patients filed out the door. Dr. Murphy and I lingered a moment.

  He turned to me, a look of concern in his eyes. “Was I too harsh?”

  “It’s a difficult but important lesson.”

  “I sense some reservation.”

  I winced. “I wish you had apprised me of your plan. I could have prepared them better.”

  “That’s rather the point though, isn’t it?” He stepped toward the door. “One of the most important skills they will need is how to think on their feet in stressful situations. They will never know what’s coming at them. If they can’t handle a surprise test question, how will they cope in the midst of war?”

  “I understand. But it appeared to me that you didn’t assign the tasks randomly.”

  “What do you mean?”

  “For example, Charlotte, who is my most empathetic nurse, had the patient with phantom limb pain. Dorothy, the most experienced clinically, got the most challenging ethical and medical dilemma. I suspect you’ve learned something about each of them. If so, wouldn’t it have been better to have switched them around, or at least randomly assigned the tasks?”

  “I’m flattered you believe I had that much forethought. I assure you I didn’t. But I think it worked out well anyway. The goal is for everyone to learn, and since the best possible person answered each question, all learned from them.”

  I stepped along with him, extinguishing oil lamps on my way out. He had a point. And I knew that part of my resistance to his method had more to do with my own territoriality regarding my nurses’ training. I had to push that aside for their own good.

  * * *

  Later, Dr. Murphy’s lesson gnawed at me. In the face of certain death, was it really inappropriate for a nurse to perform a procedure she knew full well how to do? It wasn’t merely an academic exercise; in fact, with nurses traveling the countryside between duty stations, it wasn’t unthinkable that they could come upon a similar emergency.

  I decided to bring my concerns to Dr. Murphy. I invited him to tea in the nurses’ lounge during the quiet morning hours. As I poured steaming water over a small metal ball filled with tea leaves, I asked if he thought Dorothy’s answer was truly the right one.

  “In actual practice, I believe a nurse would do all she could to save someone from certain death. But there is a difference between what we teach as policy and what an individual decides to do.”

  “Our professional guidelines hold that as long as a nurse performs as a reasonable person would, then there should be no repercussions.”

  “Exactly. She would be protected in this case.” He folded his long legs under the small chair.

  “Then why not teach that?”

  “That is where it gets fuzzy. You see, if we teach a physician that it would be appropriate to perform procedures for which he is not trained or qualified, then we are failing in our training. He must know that he is protected from being disciplined if he does all he can within his scope of practice. The moment I or anyone in higher authority tells him otherwise, we would be complicit in leading him down a dangerous path. Where would it end?”

  I poured the tea into our cups, enjoying the sweet aroma. “Biscuit?” I offered him a shortbread cookie, which he popped into his mouth whole. I was making a point of using British wording for things, thinking it would somehow help my nurses adapt to the British system once we arrived in Europe.

  “I’m afraid our scope of practice is a little fuzzy as well. We are allowed to do tasks as assigned, which can cover quite a bit of ground. Our profession is still sorting out what nurses should and shouldn’t do.”

  He scooped two spoonsful of sugar into his cup. “Well, then this is a good time to develop protocols. Add training for things that it would be beneficial for nurses to do. Remove responsibility for tasks that are not reasonable.”

  “That’s easy to say. But our nurses were trained in several different states, each having their own protocols. And they’re bound to be faced with new procedures there, ones we never saw at home. For example, I’ve read they are now transfusing blood not directly from person to person but from stored containers. I imagine that might lead to it changing from a medical procedure to a nursing one.” I popped a biscuit into my mouth and washed it down with the hot tea.

  “It’s new territory for all of us. We’ll train for as many new situations as we can think up.”

  “How do I incorporate the training from seven different states? Who decides what our nurses can do when practice at home is different from or behind what’s happening in the field?”

  He sipped his tea, purposely allowing it to steam up his glasses, then wiping them off by swiping them like the windshield wipers appearing on automobiles. He helped himself to another cookie. “That would be you, my dear.”

  I smiled behind my teacup, amused at his antic. He had a way of hitting just the right note to ease my prickly sense of authority. And now I was a “dear.” I allowed myself a moment to muse that the rumors of a romantic relationship were true but kept my eyes off him.

  * * *

  One thing I had learned back when I became a supervisor at the Harlem Children’s Hospital was that I couldn’t both lead all the nurses under me and simultaneously attend to the myriad personal and professional problems that inevitably popped up. I couldn’t both stay on top of the demands from the local community, the changes in science and practice, the continuous need for training and retraining, and listen to the sobs of a new nurse who found her work too difficult. Not that I didn’t feel for the nurse or think that a few moments with her wouldn’t be beneficial. It was simply a ma
tter of managing a finite amount of time if I was to do anything at all but work. For even with a steady habit of twelve-hour workdays, it couldn’t all be done.

  The system I was developing for Base Hospital 21 was rather like the military, with units broken down to fewer and fewer numbers until the smallest unit someone was responsible for had about eight people, much like an army squad. So I determined my sixty-four nurses would make eight squads of eight each. Each squad would have a squad leader and seven members.

  The next question was how to choose those leaders. I had my own ideas of potential leaders, nurses who had shown strength, good judgment, and reliability. Margaret, Dorothy, and Nora came to mind. But considering we had all volunteered for this mission, I thought the nurses should take part in the decision.

  At lunch one day, I handed each of them a sheet of paper. On it, I asked them to name the nurses, excepting myself, whom they would go to for advice. Whom would they go to for questions about nursing but who could also be trusted to maintain their confidence and give sound guidance?

  As I had hoped and expected, the three nurses I had in mind were on nearly all the completed papers. The other five I chose from recommendations that sometimes surprised me.

  Assigning my nurses to their squads, however, was not in the least democratic. I knew there were certain cliques I wanted to break up, a few personality clashes that were better off with a little separation. All in all, I think my system worked and freed me from having to count to sixty-four all the time. My eight little hens took care of this and so many other details for me.

  I suggested the squads come up with monikers for themselves, like combat pilots named their planes. Serious or humorous, I thought it would give them a spirit of belonging and pride. To my surprise, they all decided I should simply number them, Squads 1 through 8. Apparently, they weren’t as enamored of the quasimilitary structure as was I.

  CHAPTER 3

  Mid-May 1917

  Six weeks had flown by. We had recruited and trained to the best of our abilities and were all pawing the ground to begin our new adventure. It was time to say goodbye to our comfortable American lives. A series of train rides took us to New York City, but sadly, we had no time to explore. I had written to my family that I wouldn’t have time to see them, as we would be transported directly from Grand Central Terminal to the pier.

  The huge railroad terminal building had been completely rebuilt since I had moved to St. Louis. The new building was impressive, even to a city girl like me, with high arched windows and an immense barrel ceiling, painted like the night sky, over what was likely the grandest indoor space I had ever entered. I let the nurses wander around a bit, with instructions to meet at the big four-sided brass clock that dominated the space. I headed over to the fresh market to pick up a few of my favorite treats for the long trip ahead.

  When we met up again, the nurses were bubbling with enthusiasm, and I myself felt two feet off the ground. I liked to pretend my impressive stature, booming voice, and somewhat feigned aura of competence—after all, I knew little more about what we were about to face than did they—had helped fill them with the necessary bravado. There was no hint of cold feet; everyone was ready to go.

  As the ship sailed from the port of New York City, the nurses lined the rails and waved to the hordes of people who came to bid us farewell. The boats in the rivers tooted and blew their whistles, and their passengers cheered and waved as we passed by. Then, there was a quiet moment as we passed the Statue of Liberty. She was now mostly green, her former copper color having been painted by the winds. For most, she served as a welcome. But her beacon hand, as poet Emma Lazarus had dubbed it, also seemed to be wishing us a fond farewell.

  The weeks leading up to that moment were filled with myriad details of planning. But now, we were off on a great and important adventure. We are making history. The words ran through my mind over and over again. What an honor it was to be leading this group of women, the first to be called to serve for such duty in the U.S. Army. We were being sent to aid our allies in the Great War, in the front ranks even before our troops were ready to go.

  That evening, after ensuring all our trunks and supplies were accounted for and everyone was settled into their cabins, I made one last check before retiring. I made my way to my own cabin by first knocking and peeking into each of theirs. Maybe that seems strange; they were adults after all. But many had never ventured out of St. Louis before, and only a handful had ever been on a ship. They had been advised they could lock their doors whenever they desired privacy, but it gave me a bit of satisfaction that not a single one did. They were all so comfortable with one another and, I assumed, with me.

  My nurses slept bundled into the cots stacked like cordwood against the bulkheads. Two or three women shared each cabin, the sealed portholes and blackout curtains eliminating any sense of traveling on holiday. The air was thick with their breath and the scent of soap from scrubbed faces and hands. There was also the subtle note of sweat, an undercurrent of excitement and uncertainty running through the ship like an invisible stream.

  The SS Saint Paul, a lovely if aged ocean liner in peaceful days, had been stripped down and refitted to return to a previous mission: moving troops and support to war. The ship leaned gently from port to starboard, each cycle one minute and fifteen seconds, rocking my dear ones in peace. I hoped the last months of training had given the nurses the confidence they needed to face our enormous task.

  As I passed through the narrow corridor, the sound of retching came from the head. I rapped gently on the elaborately carved wooden door. They couldn’t strip the Saint Paul of all her glory; she let slip some of her charms like a coquette baring an ankle.

  “Yes?” The faint reply came through the slightly cracked-open door.

  I recognized the voice and was not surprised. “Miss Cox? Are you unwell?”

  Charlotte appeared in the slit of the doorway, eyes downcast in her pallid face. “It’s nothing, ma’am. Must have eaten a bit too much dinner.”

  “I’ll get you some towels to refresh yourself.” Oh dear. We were not yet on the open seas. How would this delicate flower be of any use in a stinking, bloody field hospital? She might require more assistance than she could give. Perhaps I had been too hasty in the rush to recruit such a large number of nurses. There were bound to be failures, but we could ill afford to lose them so soon.

  * * *

  During the day, the men assigned to the ship held drills on the deck, practicing marching and shooting guns out to sea. They fired artillery cannons, still on the ship from the Spanish American War, each round rocking the ship with a loud BOOM. Most of the nurses cheered at the sound and laughed at the shudder in the walls of the cabins. But my dear little Charlotte curled into a ball on her bunk. I patted her like a baby during the exercises while wondering how soon I would have to send her back home.

  As we were “invited,” so to speak, by the British, they would be supporting us throughout our assignment overseas. In fact, they were already much in evidence, as most of the stewards and stewardesses on the ship were British. And how well they treated us! I had only to glance this way and that before a steward in a sharp blue uniform appeared to ask if I required assistance.

  As chief nurse, I was grateful to have a private cabin, where I whiled away the hours checking and rechecking supply requisitions through the obtuse British system as well as reviewing the bits of information and tips mailed to me by one of the current chief nurses. Or rather a chief matron, as the British called them.

  On the second evening on board, I had a visitor to my cabin. It was Miss Dunlop, the chief nurse of the Philadelphia unit, the other group of nurses on board. They were Base Hospital 10. I had corresponded with her in recent weeks and found her to be very knowledgeable. She was perhaps in her midforties, with a streak of silver making an elegant statement in her tightly wound brown hair.

  The Americ
an Red Cross had provided all the nurses with nice dark-blue serge uniforms, but I was not having my nurses wear them on the ship except for official functions. Miss Dunlop was wearing hers, and it was as crisp as if it had met with a hot iron just minutes before.

  After introducing herself, she looked me up and down, taking in my ordinary civilian travel clothes. “Did you not receive the uniforms?”

  “We did, and there will be time enough to wear them. I thought my nurses might as well enjoy a few more days in their own clothes.”

  “Hmph. A coddler.”

  “I am no such thing.” I belatedly invited her into my cabin. We were not setting off on the right foot. “Will you join me for some tea?”

  She pulled a flask from her pocket and waggled it. “That depends.”

  I didn’t really enjoy the taste of alcohol, but the situation seemed to require imbibing. “Why, that will be a nice addition,” I said.

  As we chatted and sipped our spiked tea, she softened her attitude. She was experienced with the American Ambulance Corps and had served overseas. I was tempted to take notes as she shared stories of adapting to other cultures, but it didn’t seem proper at the time.

  * * *

  One of the challenges I found in leadership was the lack of camaraderie I had enjoyed in the early days of my career. Although I wasn’t one to share gossip, it was sure fun to hear it. And having a group of people to share daily triumphs or shed a tear with when things didn’t go well was an incredibly important support.

  Now, aside from Miss Dunlop, with whom I was not yet comfortable, I really had no peer. I did have an assistant, Miss Taylor, who was quite dedicated and competent but had made her feelings regarding personal chatter quite clear.

  Before we left St. Louis, I had invited Miss Taylor to my office for a chat about the training session with Dr. Murphy. Petite and rather frail-looking, she sat bolt upright in the chair like a frightened cat and answered all my queries with “yes, ma’am,” “no, ma’am,” or “I don’t know, ma’am.”