His stomach was red and crinkly, scarred from burns. I still didn’t remember him.
“I’m sorry. Perhaps you can remind me how we’ve met before?”
“You saved my life, you did. Maybe this will help.” He opened his collar, revealing his heavily scarred neck.
It came back to me in a flash. It was the soldier who had been badly burned at the explosion of the ammunition supply depot, whom I had encountered still in the railcar near the CCS.
I looked at the soldier’s neck, and sure enough, there was a horizontal scar, just below his Adam’s apple, amid the bumpy burns. “Yes, I remember, you had some difficulty breathing.”
“Difficulty? If you hadn’t found me when you did, I would be a goner. This”—he pointed to his freshly wounded left shoulder—“is nothing. Thank you for saving me.”
“I was just doing my job, as you are yours.”
Little did the soldier know how I had struggled within the limits of my job, even as he struggled to breathe. In this case, the system had worked. But the thought of what could have happened if the French doctor had not arrived just seconds before it was too late haunted me.
After ensuring intake was properly staffed and equipped, I moved on to the surgical lounge. It, too, seemed to be in order, so I moved on to the respiratory lounge. I had left this for last so as not to contaminate the other wards. I donned a new mask from the pile the cooks were making in their off-duty time.
It would be several weeks before we received our order of masks from the French girls. Sometimes I felt bad about asking the cooks to do even more work after they had sweated over hot stoves and steamy sinks all day. But they had told me they enjoyed the different work, sitting at a sewing machine. They enjoyed talking to the staff, asking how they could be improved.
One evening, when I was clandestinely returning my dishes from my special snack to the kitchen, I ran into Fred, chatting with Alice while emptying his pockets of pipe cleaners.
“Don’t tell me Alice has taken up pipe smoking,” I said.
Alice sat behind the sewing machine with a pile of bright print fabrics next to it. She proudly held up a mask she was working on. “Oh, now that would be a sight. No, we’re going to cut the pipe cleaners in half, then slip them into the top of the mask so’s it fits better around the nose. That’s how we made them back on the farm for when the tractor kicked up too much dust.”
“Well, aren’t the two of you clever,” I said. It seemed I wasn’t the only one who enjoyed visits with humble, cheerful, and wise Alice.
In the respiratory tent, I found Dr. Valentine supervising orderlies who were dismantling the disinfecting aerosol contraptions the nurses and I had put together.
“What is going on, Doctor?” I asked as I pinched my face mask over my nose. The piece of pipe cleaner worked just as Alice said it would.
He turned to me, his watery eyes barely visible through smudged glasses and the rest of his face hidden by a blue gauze mask. I made a mental note to advise my surgical nurses to add eyeglass cleaning to their presurgical duties. For all surgeons—we wouldn’t want to single him out.
“What does it look like? I’m repossessing vital surgical equipment that someone has stolen.”
“It wasn’t stolen. I requisitioned it. We took nothing from you.”
“Don’t give me that asinine rubbish. As if all supplies are free and unlimited. And as I believe I have already warned you, this is still a completely unauthorized use, even if you requisition it.”
“I’m in charge of the”—I waved my arms—“air in here, aren’t I? And the air needs to be disinfected.”
“You can’t disinfect the air, you fool. The solution is heavier than air and simply drops to the ground, causing a slippery mess. And how do you know you’re not damaging the lungs with whatever solution you’ve come up with? Fortunately, every time someone opens a tent flap, the air is changed. Which you would see is a good thing if you had any sense.”
“Pardon, what did you call me?” My lioness instinct awakened. “You may refer to me as Matron or Miss Stimson. This is your first and only warning. Any derogatory term toward me or my nurses will be henceforth reported.”
I let his shock of being spoken to by a nurse in such a way sink in. He worked his jaw up and down, and his eyes bulged, but he had no ground to object.
“And in answer to your complaint, aerosolized disinfectant has been used in surgical suites for a long time.”
“Are you a surgeon, Miss Stimson?”
“Fortunately not.”
“Well, stop thinking you can extrapolate the closed environment of a surgical suite to a ward full of patients.” He motioned for the orderly, who was watching all this with an amused look in his eyes, to leave. “I’ll see you at the meeting. Just in time for this decision. We need to clip your wings a bit, young lady.”
It was an uncomfortable reminder of my next task. The meeting to clarify the nurses’ roles and the limits to their duties. I rushed back to my office to pick up the notes I had been keeping on the situations that had caused conflict. I had mimeographed them and put them in the medical staff correspondence cubbies a few days previously. There were dates and brief descriptions, such as:
26 patients suffering from unknown gas admitted. No orders for removal of contaminated clothing.
14 patients admitted in respiratory distress. No oxygen tanks in wards. One patient expired while awaiting transport to operating theater.
Night shift nurses unable to obtain order for morphine.
Recommend standing orders for pain medication, isolation procedures, decontamination procedures. Request oxygen tanks be available, training for nurses, and standing orders.
Additional equipment needed on ward when supply tent and operating theater are closed at night.
The list of requests concerned me in that once something became a nursing responsibility, then it added to their already overwhelming duties. For example, giving oxygen had always been a doctor’s procedure, but it was nearly always the nurses who determined a patient needed it. How much I wanted to transfer from the doctor’s area of responsibility was a perplexing question.
When I arrived at the meeting room, a carved-out corner of the currently empty mess tent, all the doctors were already gathered around a table. The sudden silence when I walked toward them was not a good omen. It was 5:00 p.m., so I was right on time, but they must have decided to meet earlier, as they were certainly free to do. I tucked away a smidgen of hurt nonetheless. Fred was at his usual place at the end of the table, with Drs. Ernst and Gross on one side, Dr. Valentine on the other, and another I didn’t recognize on the other end. I took a place between Fred and Dr. Gross.
Fred tapped a pen for attention. “Welcome, Miss Stimson. I’d like to introduce our guest, Dr. Heinz. He is an observer from the American Red Cross.”
I nodded to Dr. Heinz. He was a thin stick of a man, with olive skin and dark curly hair. Curious I didn’t know in advance of his arrival.
“Good to finally meet you, Miss Stimson. Your reputation precedes you.”
“In a good way, I hope.”
The other doctors chuckled.
“Absolutely. I come here with guidance from headquarters regarding the question at hand, the role for nurses.” He slid a thick document toward me.
I noticed the others already had a copy, still closed in front of them. I opened mine and glanced at the headings. There were chapters for expected dress and behavior, followed by a section outlining care for each bodily system: digestive diseases and injury, skin disorders and injury, trauma of the head and neck, and so on. A brief skim of the pages revealed up-to-date practice. In fact, from what I could tell, it was the same document I had been given back in the States before we recruited the first nurse for this mission.
“I’ll need to take time to read this thoroughly, especially
any updates.”
“Indeed, we expect that. I will leave my contact information if you have any questions.”
“I have one now.”
“Of course she does.” Dr. Valentine had been rising from his chair but plopped back down.
“When was this written and updated, and by whom?” I asked.
“Why, it was written especially for us, by the experts at Johns Hopkins and other fine institutions,” Dr. Heinz replied.
“You didn’t say when,” I pushed, because it seemed Dr. Heinz had been invited so that our own medical staff wouldn’t have to make the decisions we needed. Fred, the ex-football star, would call it a “punt.”
Dr. Heinz opened the heavy paper cover and ran his finger down the first few pages. “Looks like June 1916. Very up-to-date.”
“Interesting. What does the section regarding nursing care of poison gas patients say? What does it say about caring for one hundred severely injured men who all arrive at the same time? I have a list here—”
“Thank you, Miss Stimson,” Dr. Valentine interjected. “We get the point.”
“Do you? You knew these were the questions, and yet you bring this…administrator straight from another world entirely to answer them.”
Fred spoke up. “Thank you, Dr. Heinz. We will summon you if we have further questions.”
But Dr. Heinz was not dismissed so easily. “I understand your frustration, Matron. It would be most helpful for you to create a nursing manual more relevant to your situation. I suggest you work with a member of the medical staff.” He looked around at the mostly scowling doctors, who were donning their jackets, eager to get away. “Perhaps Dr. Valentine, since he has shown so much interest, could help you.”
Dr. Valentine and I fairly glared at each other.
“I’d be delighted to work on this myself.” Fred looked at me with an unmistakable twinkle in his eye.
“Even better.” Dr. Heinz scraped back his chair and rose to leave. “Gentlemen,” he said in the way of goodbye, then corrected himself. “And lady, I bid you farewell.”
My strange discussion with Marie Curie came back to me. I hadn’t had much time to think about it. She had said that my relationship with Fred would interfere with my ability to do my job. If anything, it seemed Fred was being even more careful, seeking an outside opinion, when he could have simply made the rules himself. Was this an example of what she meant?
* * *
I returned to my office, where, thankfully, there was no line of staff waiting to see me. I needed time to make sense of the strange remarks of Marie Curie and the obstacle of Dr. Valentine. And now I had a new task to accomplish: the assignment to create an all-new policy manual. We had one for the unit already of course, based on the hopelessly vague one Dr. Heinz had brought.
I actually looked forward to working on a thorough update, especially as Fred had seen fit to work with me on it.
My time of quiet reflection was short-lived. I had barely returned from the meeting when my head late-shift nurse, Dorothy, burst through the door without first knocking.
“Matron! Come quickly!”
I hesitated only long enough to grab my stethoscope and sterile scissors. “What is it?” I followed her as she rushed back to the wards.
“It’s a leg wound. He seemed fine, then we were turning him over, and he just crashed.”
I double stepped to keep up with her. I was pretty quick on my feet, but darn if Dorothy wasn’t quicker. “Who is the surgeon on duty? Is he needing backup?”
She didn’t answer but broke out in a dead run. I followed. It was about fifty yards to the farthest ward, and it seemed that was where we were heading. Finally, we arrived at the tent. Dorothy lifted the flap, and I could see four or five nurses and orderlies crowded around a bed. There was no doctor in sight.
I pushed through the crowd to see the patient. His color was pale, his lips bluish. Clearly not enough oxygen in the blood, or sudden loss of blood pressure. His breathing was rapid but not labored, so it didn’t seem to be an airway issue.
“Where is—”
Dorothy interrupted. “The surgeons are all in theater. Ten casualties arrived all at once. This one seemed stable.”
I remembered Fred showing me the oxygen tank in the operating tent and had seen it in action since.
“Rebecca, go to surgical supply. Bring back an oxygen tank and the tubing and cannula that should be near it. Take an orderly with you; it will be heavy. Dorothy, go get a doctor who is off duty. Now!”
“We’ve already sent Margaret to do that. I don’t know why she isn’t back yet. That’s why I came for you.”
I continued my assessment of the patient. His head and neck seemed intact. He was lying on his side, so I could get a good view of his torso. A few shrapnel wounds of the chest, but none seemed to be sucking air or bleeding heavily. I quickly worked my way down his body.
“You.” I pointed at an orderly whose name I didn’t know. “Go bang on doctors’ doors until you find one. Then drag his behind over here.”
I pulled my stethoscope from around my neck and listened to the patient’s heart and lung sounds. His lungs were clear. His heart rate was 140 beats per minute. Much too fast, but its steady rhythm meant it probably was not a cardiac issue. Where was that doctor? I checked the patient’s back—nothing there.
“What is his name?”
“Dempsey. Private Dempsey.”
“I see nothing, but he has to be losing blood somewhere. Maybe an abdominal wound with internal bleeding. Help me turn him onto his back.”
“Private, we’re gonna figure this out. Don’t you worry,” I reassured the patient. He had lost consciousness, but I had learned that sometimes they could still hear you. Patients had told me that the comforting words they heard when no one thought they were listening meant everything to them.
I palpated his stomach. It was soft, indicating no internal bleeding, and the few wounds were superficial. Yet we were rapidly losing him. A trickle of blood between his legs caught my eye. I pulled up his undershorts. There was an entrance wound on his upper left thigh, and a hematoma was forming. He had been lying on this side, which was probably enough pressure to keep the blood from pouring out and us seeing it but not enough to stem the bleeding.
“Set up a blood transfusion. Do we have any citrated type O blood?”
“We can’t do that without a doctor’s order,” Dorothy said.
“Where is the goddamn doctor? Get it set up. One of you go to the operating suite and get a verbal order. Now.”
Blood started pulsing from the wound, which was directly above where the femoral artery was located. He would bleed out within minutes. “Give me a stack of gauze.” I applied direct pressure, but it wouldn’t be enough. We needed a surgeon, or this young man—he looked to be no more than twenty—was going to die. “Tourniquet!”
“We need a doctor’s—”
“Then give me a nice clean hair ribbon. I’m just going to tie it around his leg for decoration.”
My snarkiness seemed to work, as a piece of rubber tubing appeared. It had probably only been two minutes, but it seemed like an hour since we had sent for help. But still, what was the surgeon doing, strolling to the tent like it was the Easter parade?
“Blood is here, Matron.”
“Dorothy, can you start an intravenous?”
“We’re not supposed to… Yes, I can.”
The orderlies returned, lugging a green oxygen tank, a gas mask, and rubber tubing on a gurney. “How do we…”
“I don’t know. Just piece it together and open it up a little at a time.” I tried to remember the different valves in the mask from my brief lesson from Fred, but it was too hard to concentrate on that at the moment. “Put it on yourself first, and make sure there’s a good air flow.”
Margaret came rushing up, breat
hless. “Dr. Gross is on his way. He’s so slow with that limp.” She panted, hands on her thighs as she caught her breath.
“What about any of the surgeons in the operating theater?”
Margaret shook her head. “They said ten or fifteen minutes at least.”
The orderly arrived. “Major Murphy ordered two units of O negative.”
“We’ve only got the one.” The orderly opened a wooden ammo box and extracted a full bottle and some tubing and needles.
“Who here is type O? Anybody?” I said.
All who gathered shook their heads.
“Anyone know how to cross match?”
Again, silence.
Finally, my little Charlotte held up her hand. “Me, Matron. I’m type O. They collected some from me nearly two months ago and said I could give again in six weeks.”
She couldn’t have been one hundred pounds soaking wet with a monkey on her back. Six weeks as a rule for much bigger, stronger men made sense. But not for her. “Thank you, Charlotte, but that won’t be necessary.”
I could see from the blood-filled gauze and the pooling of it under the soldier’s legs that my direct pressure was not enough. I estimated he had already lost over two pints.
I considered making a small incision, finding the femoral artery, and clamping it. It wouldn’t be too hard. I could feel its pulse, although it was steadily weakening. This was far, far outside my scope of practice. Direct pressure, yes. Tourniquet? In a life-or-death emergency. Incision and basically exploratory surgery? Not on your life. Or this soldier’s life apparently. He was probably only a minute or two from expiring.
Once again, the lesson Fred had taught us back in St. Louis pushed into my mind. We couldn’t just make up rules as we saw fit in the spur of the moment. People were going to die; we couldn’t help that. We had to work with the skill and equipment we had, and if we did the absolute best we could and what a reasonable person would do, we were doing our job.
But I had already exceeded the limits of my practice by ordering oxygen and a blood transfusion and requesting orders from a doctor for a patient he hadn’t even seen. How much further should I go? What was the example to set?
The War Nurse Page 21
