“Indeed. Are there nurses at the clearing stations?”
Her face took on a pained look. “There weren’t at first. The units provided medical officers, and soldiers took turns being orderlies and such. But as the war drags on, they’re too shorthanded, so nurses have been helping to man the stations. It worries me greatly.” She looked at me with watery eyes. “My own niece serves in one.”
“That must worry you so. Do you know whereabouts she is? Maybe I can check on her now and then.”
Matron Lipton shook her head. “Not exactly. The war has been stuck in those same trenches for years now. One side lobbing whatever evil contraption they’ve come up with at the other side, then the answer back with something bigger and more deadly. A war of contrition is all. Here, we will pick up the pieces until one side gives up or runs out of sons and daughters to sacrifice for the moment.” She picked up a crumbly triangle from a tray. “Scone?”
I grabbed a plate from the shelf. “Please. So you feel safe here?”
“I think the hospital has moved once in these three years. Anything can happen, of course, but there is little time to fret about it.”
I sipped my coffee. I longed for a bit of milk in it, but there was no way I would ask for it. “I see. It seems the hospital has been fairly quiet since we’ve arrived.”
Matron Lipton chuckled. “You’ve been fortunate to arrive during a lull. But judging from our morning greeting, things will be a-hopping tonight.”
* * *
Matron Lipton was right. By four that afternoon, an ambulance arrived with four wounded. My nurses were so excited, after months of training and waiting, to actually have something to do. They flew into action, the British nurses stepping back upon seeing them at the task. With sixty-four nurses and four new patients, there was much elbowing and many a “pardon me” before I sent most of them out of the ward.
At five o’clock, three more ambulances arrived. At six, an entire unit of sixty soldiers marched up in a ragtag formation. Some carried stretchers of men wrapped in bloody bandages. I called for ten more nurses. The British nurses assigned the soldiers to beds, which they crumpled into, filthy uniforms, dirty bandages, and all. There was no apparent system. Their nurses then went down the rows of beds, taking notes and changing them into blue hospital pajamas.
I heard a nurse cry out and hurried to her. She was standing next to the bed of a patient with the fixed gaze and gray, mottled skin of death. I pulled a borrowed stethoscope from my pocket. “What happened?”
“I’m sorry, ma’am. But look here.” She pulled back the brown blanket, revealing the soldier’s fully intact right leg lying in a pool of blood. “He was chatting with me, said he walked in here and was going to walk out again.”
I checked in vain for a heartbeat. He had bled out while the nurses took temperatures and offered tea. If his injury had been properly identified, we could have saved him. “It’s not your fault, dear. I’ll summon the doctor to confirm, but I’m afraid he’s gone.”
My blood boiled. We had to create a better system. But how to impress this upon the British, who had, after all, been dealing in this theater for three years, was a delicate question. Meanwhile, the beds continued to fill up. I had to summon more nurses.
* * *
The next day was quite the same, with early morning cannon volleys followed by a trickle, then a deluge of wounded men walking, crawling, and being carried into the hospital. Throughout the day, I would hear a sound like that of distant thunder. It would grow closer and louder until I could tell it was the sound of hundreds of footfalls. Then, I would hear the singing or sometimes whistling of the men as they marched by on the street on the other side of the hedgerow. When I peeked out my window, I could see the helmeted heads as the units marched by. Sometimes they were followed by motorized artillery or tanks, the squealing and creaking of the wheels and tracks drowning out the songs of the men.
My nurses made me so proud, tackling one difficult situation after the next, my group leaders assigning them to shifts and areas of responsibilities. After three days, the guns became silent again, and I saw my chance to voice my concerns. Not with the British, as was my first instinct, but with my own chain of command.
Dr. Murphy, now a major, was the American head of the medical unit under Colonel Fife, who was the overall commander. I was considered active duty but held no rank, so in the absence of a normal chain of command, I went to Major Murphy. He also had a small office in one of the jockey rooms, not far from mine. The door was open, and he sat at a small metal desk, filling out paperwork.
I cleared my throat, but he took no notice. “Major Murphy, may I have a moment to speak to you?”
He looked up, a grin spread across his face, and he motioned to an empty chair facing his desk. “Miss Stimson. Lovely to see you. What can I do for you?”
“It’s about the intake system, sir. Or lack of one, I should say.”
He put down his pen. “Go on.”
“It’s only been a few days, but I already see a pattern. We’re losing patients who we shouldn’t.”
“This is war in a foreign country, not a peaceful day in St. Louis. We can’t save them all, Miss Stimson, or should I call you Matron?”
“Either will do.” I traced a pattern of circles onto my dark-blue uniform. “But still, there should be some order to the process. Patients should arrive having already been assessed for urgency. And to put them to bed, still in their filthy uniforms, flies against all rules of sanitation. How are we to best use those first precious minutes?”
“Again, Miss Stimson—”
Apparently neither title suited him. “Matron, yes. I think I prefer that,” I said.
“I don’t think you comprehend the horrors of the battlefield. The units are doing well just to get them here alive. In the beginning years of the war, they had quite the system. The injured were first examined by a medic in the unit, then passed back to a collection area if they needed more help. Then, they were screened, and some went to a CCS, where most got the treatment they needed, or…they succumbed.
“But as the stationary hospitals developed and the units started moving more quickly, the patients started pouring in the hospitals at a much higher rate. Now they are sorted, mostly by nurses close to the front. And they have nothing but their eyes, ears, and hands to decide if a man has a chance to be saved. Once they get here, it is up to us.”
“Then we must have our own way of sorting them.”
“That is something you can do without my approval. If you want to manage intake, I give you the authority.” He picked up his pen. “Anything else?”
“When, sir? I feel rather like a guest here. It is still a British hospital.”
“Not for long. Two weeks at most. I advise you to learn all you can from them, as we will be on our own when they leave.”
* * *
It was good advice. There was plenty to learn, and I needed to develop a system that would work before trying to make official changes. One thing I struggled with was the complex British supply ordering system. Everything needed to be explained and noted in four different places, in four different ways. Depending on the item, its cost, and where it came from, there could be any number of requests and permissions to gather. And we would be stuck with the system, because even though the British were pulling their doctors, nurses, and other medical staff, they would remain responsible for our supplies. I was eyeing some of the better clerks, planning to ask for them to stay on.
Meanwhile, the issue of how to sort casualties arriving en masse concerned me. A surgeon was heading to a nearby French base hospital to learn about skin grafts and other new ways to reconstruct faces and also to track the care from the time of injury. I decided to accompany him to observe how they handled intake of mass casualties. Thankfully, the surgeon spoke more French than did I and was able to translate what I didn’t under
stand.
The French hospital was similar to ours, nothing more than a series of tents, lined up lengthwise along the river. Ambulances delivered their wounded to the first three tents, which were called salles de triage, or sorting rooms. For most, it was obvious what the issue was. Those whose injuries were less apparent carried a tag with a word or two of explanation if they couldn’t speak for themselves. Here, basic information such as assigned unit, registration number, and family location was taken. At the same time, a surgeon did a very quick check and assigned them to either an urgent or nonurgent salle.
I followed along through the tour of operating suites and recuperation tents, making mental notes for how we could implement the best ideas into our hospital.
* * *
When I returned late that night, I found that every one of my nurses had been on duty for twelve straight hours. The Germans had fired artillery shells filled with chlorine gas, and hundreds of soldiers had poured in, coughing and choking on their own fluids. Their clothes and skin had been decontaminated in the field, but I worried how thorough that was.
Many of the soldiers had difficulty speaking and swallowing, their throats were so raw. I helped one British soldier into his bed, and he politely asked for water. He was achingly thin, his cheekbones too prominent, the bony orbits of his eyes plainly visible. He was short of breath and quite filthy and had some burns on his arms that appeared to be partially healed, but he was in no immediate distress.
“I could drink and drink, but it doesn’t put out the burn,” he said as he gratefully accepted a glass.
“Do you want to tell me what it was like?” I hesitated to ask, but his voice seemed strong, and I knew having someone listen was important.
“We weren’t prepared like we should have been. The winds were blowing from west to east, and the bloody Huns don’t like gassing themselves. But they’ve gotten more clever, using the artillery shells instead, depending on the wind.
“Anyway, we were in the trenches, and there was a faint sweet smell, not at all like you would expect. Like a peppery pineapple. Then the greenish-yellow cloud rolled over us. By the time we got our masks on, it was too late.” He shook his head.
“I did better than most. When they jumped into the trenches, I climbed out. That gas is heavier than air, so the trench is the last place to be.”
“Then why did they go in them?” I pulled a bedsheet over him, careful to avoid the burns on his arms.
“Instinct, I guess. Different gasses act different ways, so it’s hard to remember anything but getting that mask on during a panic.”
I moved on, helping to give oxygen and breathing medications and doing whatever I could to make the injured comfortable so they could rest. That, after all, was the only true cure.
I sent the weariest nurses to bed. If they themselves had no rest, they would be of no use the next day.
I had failed in my duty to properly schedule my dear nurses, allowing the Brits to determine their duties. I set up a system of a day shift and a night shift, with leaders for each. I then assigned nurses based on their experience, strength, and compatibilities. Since the evening hours were the busiest with surgeries and arrivals, I assigned the older nurses to nights, with my most senior nurse, Dorothy, in charge. This would prove to be one of the best decisions I made.
* * *
We had a small area past the last ward where the nurses could gather between shifts. It became a tiny refuge where they could talk about their struggles and triumphs of the day. It was also where they got to know one another better, sharing treats and stories from home.
I mostly left them to themselves, as they needed a place without an authority present. But occasionally, I would join them at their invitation.
It was a few weeks after our arrival, just before the British staff were to leave, when Charlotte beckoned me to meet with them.
I plopped down into the luxury of a padded chair they had saved for me and accepted a cup of tea. “Yes, my lovely ladies?”
They giggled, and Margaret, at age thirty-two one of the eldest, piped in. “We decided we needed to know more about you. Where you come from, your dreams, your worries. What you did for fun before all this merriment.”
“What if I prefer to keep that a mystery?”
They giggled again and sat forward in their seats. So much for mystery.
“I grew up in an intensely competitive family in St. Louis and later upstate New York. We children were expected to attain perfect grades, play a musical instrument flawlessly, dance acceptably, but otherwise be unseen and unheard.” I pursed my lips. “The boys were to become doctors, lawyers, or pastors, like my dad, while the girls…”
“Were to run a home and have babies,” several said in unison.
“Well, yes. But I had the misfortune of the expectation of doing something with my talents, like many in my family, while at the same time adhering to what was acceptable for girls.”
“So you became a nurse.”
“Eventually, yes. But I wanted to be a physician, like my uncle. But that was not to be.”
My nurses grew quiet, seemingly sensing a still raw point.
Charlotte’s sweet, gentle voice broke the silence. “What did you play? What instrument, I mean.”
“Oh, the violin. Not exceptionally well, but one might recognize a tune if I worked hard at it.”
“I’ll bet you were wonderful,” Margaret said.
At that, Nora elbowed Dorothy next to her. They both rolled their eyes. I could imagine they were silently saying teacher’s pet. I flashed a little glance at them to let them know I saw all.
“I do miss it.” I had not played since a time back in St. Louis, when I became overwhelmed with my work and studies. I closed my eyes and imagined the violin under my chin. I tilted my head and played with an imaginary bow. Even that made the tension in my forehead melt away.
“Is there anything else you want to know?” But I had already said quite enough.
* * *
In the next few days, I made notes of procedures and skills I thought would be beneficial and appropriate for my nurses to learn. This was a delicate dance, as we didn’t want to step on the doctors’ toes or overwhelm the nurses. But it seemed that having a bit more training in some things would save time by not having to fetch a doctor and save lives by more timely action.
I thought skills requiring lots of practice, such as suturing, were best left to the surgeons. But the field of physical assessment seemed a logical place to start. So I asked Drs. Murphy and Valentine to hold a series of clinics on things like a basic neurological exam and using a stethoscope for lung and bowel sounds. For the most part, the nurses were eager to learn new skills, but my older nurses, Nora and Dorothy in particular, had reservations.
They came to my office together after the first session, which happened to be on lung auscultation.
They were quite the pair, these two, delighting in late-night sharing of shots of whiskey. As they were both team leaders, they rarely worked together, but here they were, visiting me during precious whiskey time.
“We’ll get right to it,” Nora said as she pulled out the chairs facing my desk for Dorothy and herself.
I reached into my desk drawer and pulled out a full bottle of Jameson that had been gifted to me and a couple of glasses. “No need to rush.”
“This won’t take more than a double.” Dorothy filled their glasses. “We just want to clarify some things. This new training, I mean, it’s good for the girls to learn all they can. That’s why they came. But I worry…”
Nora filled in. Seemed they had worked it out beforehand. “We worry, when is it too much? The girls are nearly overwhelmed each day. Sure, we’ve had a few slow days, slow weeks, even. But that’s not the normal situation, and it seems the pace is ever increasing. There’s rarely a shift when I could say, gee, the nurses
had time to do so much more…”
“I understand your concern. That’s why I’ve selected topics that I thought would help the nurses in their everyday duties, not add to them. For example, a nurse might check a surgical patient for bowel sounds and, finding none, hold back on his dinner until he could be checked by the surgeon, thereby saving the patient from vomiting and herself a lot of cleaning up. That’s just an example off the top of my head. What I’m hoping for is better and more efficient patient care, not more duties.”
Nora twirled her glass. “Who gets to decide what they’re ready for?”
“As team leaders, you do.”
“One more thing.” Dorothy pointed to her tall, stiff cap that was part of the nurses’ uniforms. “Can we get rid of these godforsaken things?”
Nora chimed in, “Amen.”
“What’s wrong with them?” I despised them myself, as they were impossible to keep clean and never seemed to stay straight in my hair, no matter how many pins I used.
“The genius in Washington who picked them never worked in a tent hospital, that’s for sure,” Dorothy grumbled.
Nora added, “I knock mine off seven times a day, going through the low tent entries.”
“I see.” I always had to duck under the entries anyway, but that would not be so for the shorter nurses. “The caps are important for patients to identify us. But I’ll ask about something more practical.”
* * *
The stack of requisitions on my desk seemed to grow unchecked, despite me spending at least two precious hours each day processing them. I was tempted to lay my head on top of the stack for a moment, but a gentle knock on my door prevented any respite. “Come in.”
Charlotte flitted in and alighted like a butterfly on my extra chair. “So sorry to disturb you, Matron, but—”
“You’re not disturbing me, Miss Cox.” I couldn’t resist a peek at the watch pinned beneath my right shoulder.
“It’s regarding my room, for which I am tremendously grateful.” She tucked a blond curl behind her ear.
The War Nurse Page 6
